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PubMed1994

The "widening scope" reconsidered. Where do psychoanalysis and psychoanalytic psychotherapy meet?

This paper reviews the current status of the relationship between psychoanalysis and psychoanalytic psychotherapy and notes that, since the 1950s, the scope of indications for psychoanalysis has widened so that it has absorbed some of the clinical territory previously assigned to psychoanalytic psychotherapy. Simultaneously, these developments have brought changes in therapeutic technique and more blurring of the boundaries between these two approaches. By examining the manifestations of transference and their management both in psychoanalysis and in psychoanalytic psychotherapy, the author offers the view that these modalities of treatment, though linked in multiple ways, are basically different and that each has its preferential indications.

Humans↗
PubMed1995

Popularise and/or be damned: psychoanalysis and film at the crossroads in 1925.

Geheimnisse einer Seele'--the only film in which film producers and psychoanalysts have openly collaborated to bring psychoanalysis into the public domain--was an immediate success with the general public and reviewers and is still considered a milestone in the early history of the cinema. By contrast it caused disagreement within the psychoanalytic community, which put personal and professional relationships to a test, which Freud came to feel that 'our Circle has not passed well', and which has left the film as a millstone round the neck of psychoanalysis and its practitioners. By drawing on new documentary material and placing the 'Film Affair' in its wider context, the author aims to highlight the significance and complexity of this episode as an important event in the early history of psychoanalysis.

Freudian Theory↗
PubMed1996

Studies on hysteria one hundred years on: a century of psychoanalysis.

In this paper the author shows how 'Studies on Hysteria' ushered in a new century of psychiatry. While hysteria as a clinical entity remains as difficult as ever to define, the entire theoretical edifice of psychoanalysis rests upon it, as it allowed the discovery of the laws of conscious and unconscious thought and fantasy and thereby made it possible to explain symptoms and dreams. The author points out that many of the basic concepts of psychoanalysis are already to be found in the Studies and that, although some important ideas were thereafter forgotten, these have now come to be regarded as essential again. The notions of splitting and dissociation featured prominently in that seminal work and have now been reintegrated into mainstream theory. Present-day psychoanalysis is considered to have returned to its roots as embodied in the Studies, much less emphasis now being laid on the later concepts of drives, phases and libido theory. Female development and the woman's Oedipus complex are, in the author's view, as problematic as in Freud's day, perhaps because of his countertransference problems and neglect of the role of the mother, as exemplified in the Dora analysis. As the author shows, only the French analysts have remained consistently faithful to the concept of hysteria, whereas in other countries it no longer exists as a diagnosis. Yet the concept is stated to be important both historically and for clinical practice today.

Dreams↗
PubMed1996

The identity of psychoanalysis: the question of lay analysis.

This article, besides being a general historical account of the nature and meaning of the almost century-long controversy over "the question of lay analysis," also had a specific context and purpose. The author was invited to give the plenary keynote address to the winter meeting of the American Academy of Psychoanalysis in Santa Barbara, California, on December 9, 1994. After the passage of the Gaskill Committee proposals by the American Psychoanalytic Association in 1986, the alteration of the Regional Association agreement between the American and the International Psychoanalytical Association in 1987, and the settlement of the class-action lawsuit by clinical psychologists against the American and the International in 1988, this controversy over lay analysis had finally been resolved within the International and all its component organizations, including the American. The American Academy of Psychoanalysis, however, is one organization (with some overlap of membership with the American Psychoanalytic Association) that continues to maintain a bar against any members except medically qualified psychoanalysts. The author agreed to give the plenary address with the stipulation, which was accepted, that he could use the occasion to review this long history of the struggle over lay analysis, and to ask the Academy to reconsider its long-standing policies that now make it a lonely holdout against the evolution and resolution that has taken place in the overwhelming balance of organized institutional psychoanalysis worldwide.

Academies and Institutes↗
PubMed1976

Intersecting languages in psychoanalysis and philosophy.

The introduction establishes a general view of the literature in which philosophers have profited from their encounters with analysis. It provides a frame within which to present more specific ideas about the method and language of psychoanalysis as viewed by philosophers. The method of interpretive reconstruction is unfolded from its original context of Freud's archaeological analogy. Further, the vocabulary of reconstruction, which is an intimate part of this analogy, is employed by Anna Freud is her discussion of defense mechanisms. Texts are cited and explicated. Meanwhile, the method of reconstruction is given independent, though related, application in the work of R. G. Collingwood, an archaeologist-philosopher-historian. The juxtaposition of Freud and Collingwood suggests that the methods of philosophy and analysis are more alike than the particular problems they try to solve. Both methods are oriented toward solving the problem of discovering meaning amid absurdity. The introduction of two specific examples lends substances to this claim. In the final section on the practice of interpretation, the question is raised as to how the introduction of the method of reconstruction affects the debate about the epistemological status of psychoanalysis as a science. Psychoanalytic knowledge shows itself to be more like that available to the historian than that accessible through physical theories. Still, physics and analysis can be compared. One must look to the interpretation of symbols. In psychoanalysis, giving an interpretation--in which nonsense becomes understandable--is a form of explanation. This methodological result suggests a conclusion about the relation between metapsychology and clinical practice.

Defense Mechanisms↗
PubMed2006

What is psychoanalysis?

Although we are now less inclined to argue about whose treatment is entitled to be called psychoanalysis, we will understand current debates better if we revisualize what originally made psychoanalysis different from other treatments. At its birth, psychoanalysis twisted the common-sense treatments it grew out of into very peculiar shapes. In reaction to that extreme peculiarity, a process of normalizing began almost immediately and continues to this day. This process is illustrated by tracing the rise and fall of peculiarities in four aspects: medical procedure, the analyst's vision, the analyst's role, and the sense of time.

Defense Mechanisms↗
PubMed2006

Freud Said--or Simon Says? Informed consent and the advancement of psychoanalysis as a science.

Is it ever permissible to publish a patient's confidences without permission? I investigate this question for the field of psychoanalysis. Whereas most medical fields adopted a 1995 recommendation for consent requirements, psychoanalysis continues to defend the traditional practice of nonconsensual publication. Both the hermeneutic and the scientific branches of the field justify the practice, arguing that it provides data needed to help future patients, and both branches advance generalizations and causal claims. However the hermeneutic branch embraces methods tending to undermine the reliability of such claims, while the scientific branch aims to improve the field's empirical base - in their words, to advance psychoanalysis as a science. The scientific branch therefore has the stronger claim to the traditional practice, and it their claim that I consider. An immediate concern arises. We seem unable to answer the applied ethical question without first determining which ethical theory is correct; for defenders of the practice appeal variously to therapeutic privilege, principlism, and utilitarianism, while opponents wage autonomy-based arguments. The concern turns out to be unfounded, however, because all of these ethical approaches fail to justify the traditional practice. The more promising defenses fail partly because even the scientific branch of the field lacks empirically sound methods for establishing its causal claims and generalizations, often appealing to authority instead. I conclude that it is currently unethical for analysts to continue publishing their patients' confidences without permission, and I suggest that the field help future patients by attending to its methodological problems.

Confidentiality↗
PubMed2006

The canary in the mind: on the fate of dreams in psychoanalysis and in contemporary culture.

Dreams have been central in the birth and evolution of psychoanalysis. This paper explores the remarkable story of the relationship between dreams and psychoanalysis as a modern version of the long history of dreams in most healing traditions. But psychoanalysis seems to have turned away from dreams as central inspiration in a way parallel to the general culture's turn away from dreams and the reality of inner life. Yet modern postindustrial culture is transfixed by a version of "dream life" in ways just beginning to be understood (e.g., in the transformation of ancient interest in the inner screen to the external screen). Working with dreams in psychoanalytic psychotherapy was a creative and revolutionary act for our forebears. It is even more so today, in ways that are discussed in this paper.

Culture↗
PubMed2004

[Structural dynamics and psychoanalysis -- plea for a dialogue].

The present paper argues in favour of a dialogue between the structural dynamics and psychodynamics. This dialogue has not really taken place, but it would yield important benefits for both sides. First of all, like any other psychiatric discipline psychoanalysis needs a psychopathology as a basic science in order to find its proper place within the psychiatric field; this basic theory is granted by the structural dynamic approach. Both theories encompass many areas of clinical practice and psychological-psychiatric theory. It is worthwhile to try to translate the main concepts of the one approach into the other's terminology. Thus, specific advantages and specific shortcomings in each theory can be unveiled. Three examples are presented, the concept of the unconscious, representational theories and the concept of desactualisation. As an example of how psychoanalysis could profit from structural dynamics, the integration of neurobiological basis into a psychological concept is mentioned. The structural dynamic psychopathology may likewise profit from psychoanalysis, mainly in terms of its therapeutic application.

Humans↗
PubMed2002

The analytic process in psychoanalysis and psychotherapy: from the interpersonal to the intrapsychic level.

The current debate over the conflicting interpersonal and intrapsychic views of the analytic process may or may not help us to distinguish between psychoanalysis and analytic psychotherapy. A comparison of psychoanalysis in the English-speaking world--especially in the United States--with French psychoanalysis reveals the features that unite and at the same time divide these different psychoanalytical tendencies, both of which are the heirs to Freud's thought, in terms, in particular, of the setting (couch and chair) and of technique (interpretation, transference analysis and technical neutrality). Whereas all psychoanalytic work belongs within the framework of an interpersonal relationship, that relationship becomes meaningful only when linked to the intrapsychic dimension, which alone can open the way to the unconscious and to infantile sexuality.

Adult↗
PubMed2006

Thoughts on medication and psychoanalysis: a lay analyst's view.

The issues involved in split analytic treatments-where a second person manages the patient's medication-are discussed from the point of view of a developmentalist and lay analyst. Case material is presented to illustrate the interplay of medication with other elements of the psychoanalytic situation. Medication and its effects, it is argued, should be accorded no special status apart from other interventions and enactments in an analysis. Some see medication and psychoanalysis as parallel processes, two separate and unintegrated theoretical systems, and recommend shifting back and forth between models of the mind or becoming "bilingual"; against this view, it is argued that anything the analyst does will affect the patient's thoughts, fantasies, and even physiology in individual ways, and only attention to analytic material can reveal what an intervention means in a specific case. Success in split treatment depends on a collaborative therapeutic alliance among patient, analyst, and consultant. Because there is as yet no theory that bridges psychoanalysis and psychopharmacology, analysts must talk of these matters as incompletely synthesized and regard them as part of the challenges that make psychoanalysis the exciting, impossible profession it is.

Adult↗
PubMed1983

Treatment preparatory to psychoanalysis.

Many potentially analyzable adult patients with unimpaired egos require a period of preparatory treatment before entering psychoanalysis. There has been some concern that such face-to-face treatment, if done with the same analyst, would influence the subsequent analysis by stimulating inaccessible unconscious fantasies, gratifying infantile wishes, or making the analyst too "real." This would necessitate a change to another analyst after the preparatory treatment, in order that the analysis be unmodified and have the most profound and definitive effects. Increasingly, however, many analysts practicing in the classical tradition have found preparatory treatment compatible with progression to psychoanalysis with the same analyst. But neither this process nor the concerns about it have been described to any extent in the literature. This may be, in part, because of historical conceptions that the effects of psychotherapy rest mainly on suggestion, lack of a full theoretical framework for psychotherapy compared with psychoanalysis, and disagreement as to whether these procedures are dichotomous or on a continuum. In order to discuss most clearly the basic issues involved in preparatory treatment that progresses to analysis with the same analyst, a case is presented in which complex variables were at a minimum; the transition could be anticipated, so that interventions, which might complicate the analysis, could be avoided; and the preparatory treatment was necessary to attenuate specific resistances to the meaning of analysis. The patient described here resisted analysis as it represented the facilitator of a feared regression and the reactivator of warded-off libidinal and aggressive impulses and wishes which the patient experienced as more controllable in psychotherapy. The meanings and effects of the prior treatment and the transition on the analytic transference neurosis, resistances, countertransferences, as well as possible effects on analytic technique, are described. Although some effects on the analytic process were apparent, limitations were not observed. Also considered are advantages and disadvantages of this extension of analytic technique and why many patients, despite our best efforts, persist in avoiding analysis.

Adult↗
PubMed1986

Affect availability, tolerance, complexity, and modulation in psychoanalysis: followup of a longitudinal, prospective study.

Evaluation of 22 patients in supervised psychoanalysis showed that affect availability and tolerance changed in a positive direction during the course of psychoanalysis. In this study, we have defined criteria of change that can be clinically observed. The changes observed were present one year following the completion of psychoanalysis. Ratings of analysts' and patients' interviews, and ratings of psychological tests all revealed that patients had derived "therapeutic benefit" in relation to affect experience and management. Discriminations were made among changes in affect modulation, which reflected both loosening and tightening of controls, changes in affect availability, changes in experience of painful affects, and changes in experience of affect complexity. Analysts' interviews and psychological test data reflected notable changes in affect modulation in the direction of increased control, while patients' interviews more often reflected changes in the direction of increased expressiveness.

Adaptation, Psychological↗
PubMed1988

Interpretation, psychoanalysis, and the philosophy of mind.

I suggest that a conflict between two philosophical models of the mind so far unremarked in discussions of psychoanalysis is at the heart of questions about its status as a science, the objectivity of psychoanalytic interpretations, and the nature of the unconscious. In philosophy one model is embodied in the tradition of Descartes, Hobbes, Locke, Kant, among many others, which construes thought as prior to and independent of language. According to this tradition the mind is self-contained and mental contents or "ideas" are essentially subjective phenomena. It follows that knowledge of other minds and the material world is radically problematic. In the second and more contemporary model the phenomenon of meaning is dependent on interactions between minds, and between mind and the world. Since meaning is understood to be intrinsically social, so in an important sense is mind. I develop this second philosophic model, indicating its relevance for psychoanalysis. I also point out some of the contributions of psychoanalysis to philosophy of mind.

Humans↗
PubMed1989

Pitfalls of a one-sided image of science: Adolf Grünbaum's Foundations of Psychoanalysis.

Adolf Grünbaum's (1984) The Foundations of Psychoanalysis has received extensive attention in psychoanalytic and philosophical circles. Aspects of Grünbaum's argument are reviewed and criticized. While his volume is an important contribution to the epistemological assessment of psychoanalysis, it reflects serious shortcomings in at least four areas: its treatment of the role of suggestion in the analytic enterprise, its scrutiny of the psychoanalytic genetic method, its appreciation of analytic methodology as actually practiced, and, above all, its predication on a unidimensional, positivistic vision of science. Alternative approaches to the philosophy of psychoanalysis are suggested.

Adult↗
PubMed1999

On subjectivity and objectivity in psychoanalysis.

Epistemological subjectivism has found its way into psychoanalysis along several theoretical and clinical paths. It has developed out of the clinical interest in transference and countertransference and, in particular, from the broadly generalized definition of countertransference now popular. The clinically necessary attention to analyst-analysand interaction has been turned into interactionism or intersubjectivism and a denial of epistemological subject-object differentiation. These perspectives transform a clinical focus on the here and now of the analytic relation into the determination of the past by the present and a teleological reversal of causality. Once this reversal is made, narrative in the analytic situation becomes the co-creation of the analysand's past by the present analyst-analysand relation. Psychoanalysis, on this view, can at best substitute a coherent, novelistic account for the life history of a person. Some of the problems of subjectivism are examined here with a view to restoring to psychoanalysis the epistemology of science and common sense.

Humans↗
PubMed2003

Recent theoretical convergences in psychoanalysis and their epistemological importance.

In this paper, the author starts by examining the recent occurrence of an increasing receptivity and critical exchange between different schools of psychoanalytical thought. Among its consequences have been convergences in the understanding of countertransference, especially through the hypotheses of projective identification and countertransferential enactment. The prevalence of these hypotheses points towards the fact that the community of analysts is bringing about an informal and convergent clinical research conducted by a wide and heterogeneous range of its members. The importance and epistemological relevance of this kind of 'informal clinical research' for the construction of psychoanalytical knowledge is emphasised. This process in psychoanalysis is compared with the evolution of knowledge in other scientific areas, highlighting their similarities and their differences. The author shows how Freud's 'mystic writing-pad'model can be expanded to represent the object of psychoanalytical investigation and to bring a better understanding of the reason why the hypotheses of projective identification and countertransferential enactment occupy such a central position in psychoanalysis. In addition, consideration is given to how this kind of research can help in the difficult task of finding criteria for the evaluation of different psychoanalytical concepts. Finally, the author demonstrates how, using this approach, some of the important divergences in contemporary psychoanalysis can be viewed from a new perspective.

Biomedical Research↗
PubMed1988

[Developmental continuities of psychoanalysis and psychotherapy in Germany since 1939].

The history of psychoanalysis in Germany during the Second World War must be seen in the context of institutional and professional developments along the lines of the intersection of medicine and psychology during the first half of the twentieth century. The moral ambiguities of the integration of psychoanalysis and psychotherapy into the structures of modern industrial society were magnified and brutally supplemented in the course of the partial professionalization of these disciplines in Germany under the Nazi dictatorship. A study of the continuities in the history of psychoanalysis and psychotherapy in Germany since 1939 can provide insight into the moral and practical vicissitudes of professionalism in modern society as well as into the social history of Germany under Hitler.

Germany↗