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PubMed2003

In search of the elusive nature of clinical psychoanalytic theory.

Two case vignettes illustrating different ways of listening to clinical material are presented. The author discusses some limitations of clinical psychoanalytic theory that stem from the fact that primary unconscious processes are, by their very nature, impossible to describe in a language regulated by secondary processes. Hegelian dialectics, first addressed in psychoanalysis by Lacan and later elaborated in the work of Green, as well as the use of paradox by Winnicott and the formalistic approaches of Matte Blanco and Bion, are briefly reviewed as alternative formulas. As psychoanalysts, we are condemned to live with doubt, and neither clinical theories nor metapsychology offer escape from this reality.

Adult↗
PubMed2003

Idealization and psychoanalytic learning.

Idealization is an intrinsic part of psychological maturation, but it is also a potential barrier to psychoanalytic learning, and must to some degree be outgrown if an analyst is to develop a natural authority and individual style. Unrecognized idealizations stifle analysts' engagement in the transferences of their patients, and so compromise the ability to freely experience and analyze them. Attention to real life and the lessons it teaches counterbalances the tendency to idealize and encourages lifelong psychoanalytic growth.

Awareness↗
PubMed2004

The psychoanalyst as individual: self-analysis and gradients of functioning.

The authors discuss the position of the analyst as an individual and the idea that his mental functioning can be seen as a meaningful element of the analytic field. The first part of the article shows the importance of the analyst's self-analysis, with particular attention to periods when the analyst is facing a difficult time, self-analysis in supervision, and the exploration of transgenerational influences. The authors go on to discuss the many gradients of the analyst's mental functioning, and these are mirrored in the patient's text, an indication of attunement.

Adult↗
PubMed2004

One form of self-analysis.

Beginning with Freud, psychoanalysts have discovered media through which they may achieve a self-analytic experience (for example, by use of dreams, fantasies, reveries, memories, and even visual images). Each of these media is a kind of "fiction" created by the analyst that provides an imaginative space where he or she may gain access to unconscious life. The author demonstrates how a generative self-analytic experience may be accomplished through the medium of psychoanalytic writing: a fictional autobiographical form of writing through which a self-analytic experience is created that has much in common with the analytic experience created by the analyst and analysand.

Autobiographies as Topic↗
PubMed2004

Saying the right thing at the right time: a view through the lens of the analytic process scales (APS).

Skillful psychoanalytic technique presumably involves knowing what to say, and when and how to say it. Does skillful technique have a positive impact upon the patient? The study described in this article relied on ratings by experienced psychoanalysts using the Analytic Process Scales (APS), a research instrument for assessing recorded psychoanalyses, in order to examine analytic interventions and patient productivity (greater understanding, affective engagement in the analytic process, and so on). In three analytic cases, the authors found significant correlations between core analytic activities (e.g., interpretation of defenses, transference, and conflicts) and patient productivity immediately following the intervention, but only if it had been skillfully carried out. Findings were independently replicated by psychology interns.

Adult↗
PubMed2005

Patients reading about themselves: a stimulus to psychoanalytic work.

Patients' reading of their psychoanalysts' papers about them as a vehicle for psychoanalytic work is a relatively new phenomenon in the field. Over the past five years, reports of analysts' employment of their writing in this fashion have begun to appear in the analytic literature. This paper presents clinical illustrations of this specific use of analysts' writing. These illustrations were drawn from interviews with analysts who published clinical articles in Psychoanalytic Dialogues between 1995 and 2003. The author considers some of the clinical and scientific implications of this use of papers written for publication.

Countertransference↗
PubMed2006

The wish for revenge.

The wish for revenge is a ubiquitous response to narcissistic injury, and particularly to the narcissistic injury that accompanies oedipal defeat. Vengeful fantasy serves to represent and manage rage and to restore the disrupted sense of self and internalized imagining audience that have resulted from injury. Clinical and literary examples demonstrate the split within the representation of the self and the imagining other that underlies the wish for revenge, and the way that this split operates differently in the psychic economy of the transiently and the chronically vengeful.

Adult↗
PubMed2006

Forging difference out of similarity: the multiplicity of corrective experience.

In the context of work with an adult survivor of childhood sexual abuse, the interplay of multiple forms of engagement contributing to therapeutic action is explored. The compulsion to repeat old patterns is seen to be gradually overcome by new corrective experience in which the whole of the patient's sense of the analyst as a person is greater than the sum of its parts. Interpretation of enactments--often involving patterns of dominance and submission--is complemented by a range of "helpful" actions that must be detoxified. That process entails the progressive differentiation of coercion and influence, on the one hand, and of compliance and responsiveness, on the other In the end, autonomy and creative responsiveness emerge as integral to each other rather than as mutually exclusive. This development requires that the patient gradually relinquish an "essentialist" view of self and other in favor of a "constructivist" view, in which the ambiguity of experience offers opportunities for new forms of relational engagement and understanding.

Adult↗
PubMed2006

Trauma, reverie, and the field.

The author uses a clinical vignette to demonstrate complex concepts at work--concepts such as those derived from a productive grafting of Bion's thinking onto the concept of the psychoanalytic field. The underlying theory is narrated by the use of images, which the author finds to be the most appropriate way to demonstrate this theory at work--a theory of the mind based on the concept of digestibility of emotions, as well as the progressive introjection of instruments to render such an operation possible. Key points include the waking dream thought, the analyst's reverie, unsaturated interpretations, continual re-dreaming on the content of the session as permitted by the field, and the development of the ability to metabolize emotional contents.

Countertransference↗
PubMed2001

Altering women's relationships with food: a relational, developmental approach.

Eating disorders, ranging from body-image distortions to full-blown anorexia nervosa and bulimia nervosa, reflect developmental issues and significant deficits in feelings of self-efficacy. The relational model, an outgrowth of theoretical work specific to the psychology of women, is an appropriate treatment approach. This model appreciates the social context and pressures that foster disconnection from the self and helps the woman to reconnect with self and others, decreasing the need for obsessive control over food and weight. Treatment emphasizes empathy, connection, mutuality, and authenticity and views disconnections and disruptions as the predisposing, precipitating, and perpetuating factors related to eating disorders. The client-therapist relationship is central to this model as demonstrated by a case illustration.

Adult↗
PubMed2002

A cognitive perspective on resistance in psychotherapy.

The phenomena that comprise resistance in therapy are described and discussed from a cognitive viewpoint. The cases of Brian, Julie, and Victoria are reviewed to illustrate similar and contrasting manifestations of resistance, and suggestions for further individualized conceptualization and intervention are presented. Emphasis is placed on gaining an accurate, empathic understanding of the client's difficulties in changing. This is coupled with methods that allow the client some autonomy in charting the course of therapy, at the same time reinforcing the importance of the therapist's active involvement in educating and stimulating the client toward greater awareness and adaptability. In order to be maximally effective in encouraging such changes, therapists must be aware of their own tendencies to react adversely to client resistance. It is vital that therapists maintain their professionalism and confidence in persevering toward a better understanding of what will be helpful to their clients.

Adaptation, Psychological↗
PubMed2002

A gestalt-experiential perspective on resistance.

The authors present background on the gestalt-experiential understanding of resistance, conceptualized to be either resistance to awareness or resistance to contact. The authors discuss why they do not use the term resistance and describe the phenomena as a client's self-protective attempt to avoid the anxiety necessitated by change. Such resistant behaviors occur outside a client's awareness and often result in an ambivalence or conflict about change. The authors also describe using in-session experiments as a way to engage with the client in exploring such a state of ambivalence or conflict. Finally, they respond to the case studies presented elsewhere in this issue and propose intervention strategies consistent with the gestalt-experiential perspective.

Adult↗
PubMed2002

An interpersonal communication perspective on resistance in psychotherapy.

This article discusses resistance in psychotherapy using the contemporary interpersonal communication model of psychotherapy. This perspective defines resistance as moments during sessions when the patient and therapist are interacting with one another in such a way that the patient is kept from becoming aware of any covert experiences or transactional patterns that are conflictual and anxiety provoking. The ways in which resistance may be conceptualized and worked with are discussed and applied to three patient vignettes, with an emphasis on working with resistances as they are manifested in the patient-therapist relationship. Some of the potential reactions of the therapist to resistance are discussed, including some relatively beneficial and some problematic instances.

Adult↗