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PubMed1983

[" Do you believe everything I tell you? "].

This text, first in a narrative, then in a reflective form, deals with the following themes : the world of children in its specificity, their imagination needs, and its function for them in critical situations, and also their need for personal space. The critical situation referred to here is the perilous period with which children of depressed mothers must deal : how are they able to maintain their own momentum to keep their access to desire, their right to pleasure? The use that the child can make of psychotherapy in this case is seen, as is the place and the role of the therapist's countertransference in this work with the child.

English Abstract↗
PubMed1991

The addiction to negativity.

In this paper, we have described a type of resistance that has attracted increasing psychoanalytic attention in recent years. Patients exposed to intense negativity during early life may develop an addiction to negative experience as adolescents and adults, and this may constitute a central organizing feature of their personality. In almost all patients, however, some moments of negativity may be observed. We have traced the developmental origins of an attachment to negativity, drawing especially on psychoanalytic investigations of preoedipal pathology. Manifestations and derivatives of early negativity include anhedonia, attachment to physical pain, fear of success, masochism, deprivation of self and others, and negative voyeurism. In discussing the dynamic functions of negativity, we place particular emphasis on two motives: the patient's desires for revenge against early objects that have been a source of deprivation and frustration; and the defensive function of negativity in helping to express as well as ward off dangerous wishes to merge with the object. Deviant forms of autoerotism are likely to be used by these patients to deal with the reactivation of early experiences of neglect and rejection. When negativity is used as a defense or method of relating to others it can lead to a severe disruption of the psychotherapeutic relationship. We have reviewed suggestions for the management of extreme negativity in treatment. Resolution of the therapist's countertransference reactions, especially induced feelings of frustration, rage, and helplessness, is crucial. Emphasis also has been placed on the patient's desires for revenge against self and object, and the manner in which these may be understood and eventually resolved. Only when patient and therapist begin to investigate the adaptive functions of extreme negativity can this pathological symptom be resolved and the patient's awareness of self and sense of autonomy be enhanced.

Adolescent↗
PubMed1991

Thinking about thinking: some clinical and theoretical considerations in the treatment of a borderline patient.

This paper addresses a specific aspect of pathological mental functioning in so-called borderline patients. Analytic work with a borderline man is presented to show that an inhibition of, and defences against, the contemplation of one's own and others' mental states may be a hallmark of the resistance encountered in a number of such patients. It is claimed that the analysis of transference and countertransference is a crucial therapeutic factor in tackling this source of resistance. In doing this, the paper draws upon a topical notion from philosophy of mind and recent ideas from child development studies which help to clarify psychoanalytic ideas concerning the nature of the pathology of internal object relations underlying feelings of emptiness and social alienation in borderline functioning.

Adult↗
PubMed1991

Aspects of a dilemma of middle age: whether or not to place aged, failing parents in a nursing home.

A middle-aged person's involvement in making a decision about whether or not to institutionalize an aged parent whose physical and/or mental capacities have failed inevitably arouses intense feelings, memories, fantasies, and conflicts. Fantasies that equate putting the parent in a nursing home with abandonment and murder, as well as the narcissistic threat posed by seeing one's own future in a parent's deterioration, are common. The conflicts aroused may upset long-standing psychological balances. This paper explores ego, superego, id, and reality issues that are aroused as they were seen in the psychoanalysis and psychotherapy of several patients involved in making this decision. The importance of looking for the unique aspects of the conflicts set off in each individual facing this dilemma is stressed, as is the potential for countertransference responses.

Aged↗
PubMed1991

Patients' theories of pathogenesis.

Certain patients embark upon analytic treatment with well thought out theories regarding the origins of their difficulties. Although there is always some validity to such theories, they turn out to be incomplete and serve to screen painful recollections and pathogenic unconscious wishes and the defenses against them. Two cases are presented to illustrate how analysands use these theories in the service of resistance. Painstaking analytic work is required to elucidate their defensive nature. The narcissistic importance of such theories in maintaining a coherent narrative about one's life in the face of uncertainty is discussed, and technical and countertransference considerations are explored.

Adult↗
PubMed1990

The superego in patients' dreams in group analysis.

The paper gives an introduction to the superego in patients' dreams in group analysis and presents new contributions to the theory of the superego. The following aspects are dealt with in more detail: the superego as resistance to change, the superego in the group, the dream is the group--the group is the dream, uncovering the superego in a group member's dream, possibilities of therapeutic action on the superego in the group, working with a member's dream in the group, countertransference reactions to "superego-dreams" in the group and the therapeutic effect of the "superego-dream" analysis in the group.

Dreams↗
PubMed1990

The psychotherapy of mania.

The manic or hypomanic patient paradoxically lives on the edge of loss and lowered self-esteem. This is due to present realities of the impact of the illness upon life and the prospect of cycling into depression and earlier developmental problems to which bipolar patients may be especially prone. Furthermore, manic behavior itself engages others in arguments and countertransference problems that may actually worsen the course of the illness. A psychotherapeutic approach taking these factors into account can have a favorable impact on the acute episode and the long-term course of the illness, provided the patient and psychiatrist are able to form a trusting relationship that survives any recurrences. Justification for these views derives from small series of patients and anecdotal impressions of experienced clinicians. Empirical research is needed on the efficacy of psychotherapy, independent of medication effects.

Bipolar Disorder↗
PubMed1990

Incest perpetrators in group therapy: a psychodynamic perspective.

Patients who have been sexually abusive toward children in their family often have guarded prognoses. However, the legal system's promotion and support of treatment elicits cautious optimism; even limited progress can make a significant difference in the lives of these persons and their families. The authors report on their work with incest perpetrators in a psychoanalytically oriented psychotherapy group with 20 incest offenders (selected after evaluation of 50), describing major obstacles (i.e., patients' lack of motivation and countertransference) and frequent clinical issues (i.e., perversion, psychopathic tendencies, low self-esteem, and substance abuse).

Adult↗
PubMed1990

Psychoanalytic perspectives on the use of medication for mental illness.

The author examines the use of psychoactive medication from the psychoanalytic perspective. He notes that medication has psychological meaning and acquires additional mental representation, and that pharmacotherapy interventions may obscure the differentiation between direct effects of medication on patients and neurotic conflicts in patients. He discusses specific factors involved in the decision to prescribe medication, including the patient's and the clinician's own readiness to use medication, medical countertransference, and common pharmacotherapy interventions (suggestion, manipulation, and inexact interpretation). A case report illustrates issues involved in combined psychoanalytic and neurobiological treatment.

Adult↗
PubMed1990

Gender and identity issues in the analytic process.

The influence of gender--of analyst and analysand--in the unfolding of the analytic process is being addressed. A brief discussion of the reasons why such influence was either dismissed or denied in the analytic literature until recently, is followed by an overview of possible analyst-analysand interactions in the four gender-related dyads. Finally two specific developments, not uncommon in the transference of female patients in analysis with female analysts (and their countertransference implications) are presented. The first refers to the issues around closeness and distance with the maternal object (usually expressed as issues over control and as a sado-masochistic struggle with the analyst in the transference), while the second to the erotization of the transference.

Acting Out↗
PubMed1990

[Hidden interpersonal structures in medical and psychotherapy interaction with foreign patients--presented and discussed with the example of a Turkish patient with chronic pain].

Doctors an psychotherapists often are confronted with many difficulties in the treatment of migrant workers with psychosomatic complaints: differences in language, social class, ethnicity and cultural origin take influence on the genesis of illness and the diagnostical and therapeutic processes. In a project for development of psychosomatic treatment of Turkish migrant workers and their families, psychotherapy was carried out with the help of Turkish translaters. A course of treatment of a Turkish out-patient suffering from chronical pain syndrome is recorded with regard to the transference, countertransference, possibilities and bounds of cross-cultural psychotherapy with migrant workers.

Acculturation↗
PubMed1990

Psychoanalysis: the common ground.

This paper carries further the theme I developed in my presidential address in Montreal, 'One psychoanalysis or many?' where I discussed the issue of what holds us together as psychoanalysts sharing a common discipline and science despite our increasing theoretical diversity. My response was that our common ground rested in our shared clinical enterprise in our consulting rooms where we relate comparably to the immediacy of the transference-countertransference interplay with our patients. In this paper I reconsider these perspectives in the light of the specific responses to them, including in the six pre-published statements for the Rome Congress which was dedicated to this theme of exploring our common ground; and I then apply these conceptions in my own comparative assessment of the three plenary clinical presentations of the Rome Congress, drawn from the three major world regions of psychoanalytic activity and presented by adherents of three of the major metapsychological perspectives in our field, the ego psychological, the Kleinian, and the object relational.

Adult↗
PubMed1990

[Meaning without words, word without meaning: forgetting of "aliquis". Remarks on Grünbaum's critique of repression].

The author addresses the critique of the psychoanalytic concept of repression developed by Grunbaum in regard to Freud's interpretation of forgetting in the "aliquis episode". Reiff counters by pointing out the indispensability of a hermeneutic approach to the transference-countertransference process and supports his contention with case illustrations and with reference to the psychoanalytic discussion of symbolization.

Adult↗
PubMed1986

Twenty-five years and thirty days.

One can imagine the history of psychoanalytic literary criticism (like psychoanalysis itself) as three phases, each enlarging and including the previous one: a classical phase that studied the oedipal conflicts of literary figures; an ego psychology that addressed literary structures; now, a psychology of the self that uses associations to unfold and deepen one's relations to literature. Psychoanalytic criticism used to be disdained in literary circles, but has become highly fashionable, for today other kinds of criticism also use associations. They do not acknowledge the critic's self or countertransference, however, and their psychoanalysis is not the clinician's.

Association↗
PubMed1988

[Institutional psychotherapy for the suicidal patient].

On institutional psychotherapy of suicidal patients. Some basic principles of the psychotherapeutic treatment of suicidal patients in the clinical setting are discussed. The importance of a reliable, supporting, and trusting relationship is stressed. The activity and the flexibility of the therapist present essential elements of the psychotherapeutic practice. The most important characteristics of the clinical milieu regarding the treatment of severely suicidal patients are pointed out. Countertransference reactions, frequently reflecting the psychodynamics of the patients, must be controlled. Besides, it is necessary to accentuate therapy differently depending on the diagnosis of the patient.

Hospitals, Psychiatric↗
PubMed1979

The concept of therapeutic alliance: implications for the "widening scope".

As a result of studies in ego and developmental psychology, psychoanalytically oriented psychotherapy, empathy, countertransference, and object relations, the sphere of interest in psychoanalysis has been extended beyond the patient's intrapsychic life to embrace all aspects of the therapeutic relationship. A significant contribution to this trend has been a study of the collaborative aspects of the analytic relationship as exemplified in the concepts of therapeutic alliance and working alliance. A historical survey of writings on this subject serves as a background for a critical examination of the theoretical and clinical implications of these concepts. These studies have provided a useful conceptual basis for the understanding of many "given" aspects of the analytic relationship, delineating those personality attributes which make collaboration in the analytic work possible. This in turn has been helpful in making appropriate applications of psychoanalytic principles in the therapy of a broader range of clinical conditions. It is suggested that, along with the gains achieved by making explicit the rational and irrational elements of the collaborative aspects of analysis, there is also the danger of a shift of focus away from the nuclear analytic concepts of unconscious intrapsychic conflict, free association, and interpretation of transference and resistance. This danger lies especially in the tendency to see the therapeutic alliance as an end in itself--to provide a new and corrective object relationship--rather than a means to the end of analyzing resistance and transference.

Consciousness↗
PubMed1989

Long-term treatment of chronically suicidal patients.

Chronically suicidal persons with chronic psychiatric disorders (dysthymia, recurrent depression, alcoholism/addiction, schizophrenia, personality disorders) challenge the experience and resourcefulness of psychiatrists. The author reviews his 30 years of experience with these patients and makes six recommendations for long-term treatment: (1) a team approach using consultants and ancillary therapists, (2) flexible therapeutic plans combining medication with psychotherapy, (3) care in monitoring transference and countertransference, (4) brief hospitalization at turning points in the patient's life or in the treatment, (5) decisions based on risk-benefit evaluation, and (6) appropriate record keeping. He also summarizes effective treatment approaches with patients who have chronic psychiatric disorders.

Chronic Disease↗
PubMed1989

Posttraumatic stress disorder. A historical perspective on diagnosis and treatment.

The author explores new directions in the diagnosis and treatment of posttraumatic stress disorder (PTSD). Psychological, biological, and sociological findings are contrasted with earlier developments to provide historical continuity. The author addresses such topics as developments in psychoanalytic theory, information-processing theory, normal stress response, multitheoretical syntheses, countertransference, and pharmacological approaches.

History, 19th Century↗