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PubMed2004

This art of psychoanalysis. Dreaming undreamt dreams and interrupted cries.

It is the art of psychoanalysis in the making, a process inventing itself as it goes, that is the subject of this paper. The author articulates succinctly how he conceives of psychoanalysis, and offers a detailed clinical illustration. He suggests that each analysand unconsciously (and ambivalently) is seeking help in dreaming his 'night terrors' (his undreamt and undreamable dreams) and his 'nightmares' (his dreams that are interrupted when the pain of the emotional experience being dreamt exceeds his capacity for dreaming). Undreamable dreams are understood as manifestations of psychotic and psychically foreclosed aspects of the personality; interrupted dreams are viewed as reflections of neurotic and other non-psychotic parts of the personality. The analyst's task is to generate conditions that may allow the analysand--with the analyst's participation--to dream the patient's previously undreamable and interrupted dreams. A significant part of the analyst's participation in the patient's dreaming takes the form of the analyst's reverie experience. In the course of this conjoint work of dreaming in the analytic setting, the analyst may get to know the analysand sufficiently well for the analyst to be able to say something that is true to what is occurring at an unconscious level in the analytic relationship. The analyst's use of language contributes significantly to the possibility that the patient will be able to make use of what the analyst has said for purposes of dreaming his own experience, thereby dreaming himself more fully into existence.

Dreams↗
PubMed2004

The shaping of masculinity: Revisioning boys turning away from their mothers to construct male gender identity.

This paper offers an understanding of the nature of the internalization processes involved in the shaping of male gender identity founded on the boy's unique struggles in separating from his mother. The underpinning for the initial development of a sense of masculinity is reconsidered as the author questions the widely held idea of Greenson and Stoller that a boy normatively has to 'dis-identify' from his mother to create his gender identity. Import rather is placed on the conscious and unconscious aspects of the mother's (and father's) pre-oedipal and oedipal relationship with their little boy in order better to understand the nature of the boy's unique identifications and subsequent sense of masculinity. Both the security of the boy's attachment to his mother, in providing the foundation for a transitional turning to an 'other', and the mother's capacity to reflect upon and recognize her own, as well as the father's and her son's, subjectivity and maleness, are crucial in comprehending boys' 'attachment-individuation' process. Likewise, the unconscious paternal and maternal imagos and identifications of both the boy's mother and father, as well as the father's pre-oedipal relationship with his little boy and the boy's mother, are extremely significant in shaping a son's gender identity. The author argues that these early maternal (and paternal) identifications live on in every male and continue to impact the sense of maleness in a dialectical interplay throughout the life span. A maturing gender identity develops from integrating these early, pre-oedipal maternal identifications that no longer need be repudiated nor defensively organized as polarized gender splitting.

Adolescent↗
PubMed1999

On discriminating and not discriminating between affect and representation.

The topic involves two issues. They can be related either to different clinical pictures or to divergent opinions about the same clinical facts. But the above mentioned opposition can be found in Freud's work. Listening in analysis differentiates between situations where the distinction of affect and representation is blurred within the general frame of communication and others where this distinction imposes itself because of the critical or chronic character of the predominance of affect. Problems about the discrimination between affect and representation in the unconscious are elucidated in the light of their structural differences. The notion of the psychical representative of the drive announces the reference to the further notion of instinctual impulse. Later on, in Freud's theory, the notion of instinctual impulse has encompassed the distinction between affects and representation. Contemporary authors have, in their vast majority, chosen to refer preferably to object relationships. Nevertheless, the problems raised by Freud remain unanswered. It is with the clinical picture of borderline personality disorders that the lack of discrimination between affect and representation becomes evident. A detailed description is presented of the forms of transference where the irrepresentable prevails, accompanied by feelings of being overwhelmed, repetition compulsion, acting out and somatic reactions. In the countertransference, the affects of helplessness, despair and even the impossibility of grasping the meaning of the patient's communication are frequently met in the analyst. In these clinical pictures, intermediary formations, i.e. psychic organisations where primary processes structures the unconscious, are impaired. One is struck by the limitation of the capacities of representation and by the importance of phenomena related to negative hallucinations specially focused on thought processes, The communication is frequently self-contradictory, the transference oscillating between disembodiment and primitive fusion. The object has a paradoxical status; it is at the same time everything and nothing, the transference being incomprehensible and unanalysable. Different hypotheses are presented to explain the importance of destruction. Finally, the author presents a hypothesis for the deficiency of these intermediary formations because of the absence of continuing cathexis from the primary object at certain important moments of the relationship. It is the establishment of theses intermediary formations that will permit the acceptance of the separation from the object, the child now being able to rely on his own internal creations. However important the influences of the relationship to the other in the genesis of affects, the internal orientation towards the body of the psychic processes is what constitutes the core of the primordial psychic world.

Affect↗
PubMed1999

Male gender identity and sexual behaviour.

One consequence of a heightened interest in intersubjectivity in the current psychoanalytic literature has been a relative neglect of the examination of unconscious fantasies. Presenting material from the analysis of three males, each of whom, in childhood and/or adolescence, hid his penis between his legs and looked at himself in a mirror naked, the author demonstrates the importance of attending to both unconscious fantasies and their manifestations within the interactive field of analysis. The first patient is a young child with a gender identity disorder, whose wish to be like his mother was a response to the emotional loss of her during early childhood. The second patient is an adolescent, whose behaviour in front of a mirror was a manifestation of his desire to possess his mother and be her, to humiliate and sadistically control her, and at the same time, to experience the masochistic sexual gratification of being a seemingly helpless victim. The third patient, a 48-year-old male, came to analysis filled with suicidal impulses and self-hatred related to homosexual impulses. His repeated examination of himself in a mirror, with penis hidden, reflected severe castration anxiety, related to an ambivalent relationship with an angry mother and a longing for attention from an unavailable father. The article closes with a description of the similarities and differences in the dynamics of these three males as well as a discussion of the meaning of similar behaviour in other males seen in consultation.

Adolescent↗
PubMed2006

Critical reflections on intersubjectivity in psychoanalysis.

The authors review the philosophical trend known as postmodernism and the way it has influenced a part of psychoanalytic thought, concluding with some comments on the qualities and shortcomings of the new developments. The authors consider the origins and the cultural and aesthetic-philosophical meaning of postmodernism, identifying some key concepts such as deconstructionism, the disappearance of the 'individual subject' and individual identity, and the rejection of 'in-depth' models of psychoanalysis. Then they examine various, wide-ranging developments in psychoanalytic thought and treatment. They review the intersubjective field in psychoanalysis, especially in the USA, and then explore whether the underlying lack of truth to be discovered, stressed by these 'new view' statements, or the fact that the 'truth' only exists in linguistic-narrative constructions is consistent with basic analytic concepts such as the unconscious, phantasy, transference and countertransference, which recall the tri-dimensional nature of inner psychic reality. The psychoanalytic process is a condition activated through a bond that is able to hold and contain the relationship of the analytic couple and the patient's unconscious world and not through hermeneutic or narrative constructions.

Countertransference↗
PubMed2006

The act of interpretation.

The author understands the interpreting act as an attempt to perceive what happens in the transference/countertransference field and not just what happens in the patient's mind. Interpretation transcends mere intellectual communication. It is also an experience in which analysts' emotions work as an important instrument in understanding their patients. Interpretation is seen to possess manifest as well as latent content; the latter would contain the analysts' feelings, emotions and personality. The unconscious content of an interpretation does not inconvenience or preclude the development of the analytic process, but, on the contrary, it allows new associative material to emerge, and it transforms the analytic session into a human relationship. Analysts' awareness of this content derived from patients' apperceptions is a significant instrument for understanding what is happening in the analytic relationship, and what transpires in these sessions provides fundamental elements for analysts' self-analysis. Some clinical examples demonstrate these occurrences in analytic sessions, and how they can be apprehended and used for a better understanding of the patient. The author also mentions the occurrence of difficulties during the analytic process. These difficulties are often the result of lapses in an analyst's perception related to unconscious elements of the relationship.

Awareness↗
PubMed2006

The controversial discussions and après-coup.

The author suggests a distinction between what is descriptively named après-coup, and what is dynamically identified as après-coup. This parallels Freud's distinction between the descriptive unconscious and the dynamic unconscious in the topographical model of the mind. The descriptive après-coup refers to the way in which the concept has found a use, especially but not only in the French literature, to refer to retrospective signification in the moment-to-moment progress of a session. The author outlines dynamic après-coup and she suggests it is at the core of Freudian metapsychology. Dynamic après-coup establishes a link between trauma, castration, repetition compulsion, sexuality and temporality in the context of the transference.

Adult↗
PubMed2005

The countertransference dream.

Can the analyst's night-dream about his patient be considered as a manifestation of countertransference--and, if so, under what conditions? In what way can such a dream represent more than just the disguised fulfillment of a repressed wish of the analyst? Is there not a risk of the analyst unconsciously taking up and 'using' the content of a session or other elements coming from the analytic situation for his own psychic reasons? The author, closely following Freud's dream theory, shows the mechanisms which can allow us to use the dream content in the analytical situation: preserved from the secondary processes of conscious thinking, other fantasies and affects than in the waking state can emerge in dream thought, following an 'unconscious perception'. After examining the countertransference elements of Freud's dream, 'Irma's injection', which leads off The interpretation of dreams, the author presents a dream of her own about a patient and its value for understanding affects and representations which had hitherto remained unrepresented.

Countertransference↗
PubMed2001

Acute enactment as a 'resource' in disclosing a collusion between the analytical dyad.

The author discusses various aspects of the function of enactment in analytical practice, reviewing the concept, then describing a borderline patient with whom the analytic process seemed to be developing productively. Following a change in the setting, an intense, acute enactment took place. Understanding this led to observation of an unconscious collusion, in which a symbiotic relationship had been established between the patient, the analyst and his family, as a chronic enactment. This relationship had prevented the analyst from touching on highly destructive unconscious fantasies and archaic traumatic situations. Comprehension of the enactment enabled the collusion to be dissolved. The author suggests that, besides the resistance aspect, the collusion may have been useful in strengthening the patient's mental mechanisms and trust in the analytical work, which required some time. The acute enactment arose, unveiling the collusion, when the patient and the analyst felt able to face the terrible feelings related to the triangular situation. He speculates that both enactments may occur in the analysis of these kinds of patients, as part of the 'natural history' of the analytical process, and their function is to relive archaic experiences in the analysis, also with the aim of working them through. Finally, the author proposes a classification of enactments: normal, pathological, acute and chronic.

Acting Out↗
PubMed2005

Who is 'who' in dissociation?: A plea for psychodynamics in a time of trauma.

Contemporary theories of dissociation and trauma for the most part have evolved outside of psychoanalysis. Psychoanalytic writings have also been regarded as being in opposition to trauma-based notions of human psychopathology. The specific psychoanalytic contribution--the emphasis on unconscious conflict and meaning--is for the most part excluded from the discourse on dissociation, often resulting in a 'mechanic' conceptualisation of trauma. In this paper, based on clinical material, the author argues in favour of including conflict, unconscious intention and personal meaning in understanding the kind of dissociation we see in cases of multiple personality pathology. Textual analysis of letters written to the analyst illustrates how events of abuse are defensively elaborated. The author demonstrates that patterns of affect regulation and dominant object-relational strategies can be captured through analysis of the discourse structure. She focuses on how an organised character pattern, revealed mainly through narrative style and the analyst's countertransference, serves protective purposes as well as wish-fulfillment. She argues that dissociation in the form of multiple personalities may imply an active, strategic agent.

Adult↗
PubMed2005

Leonardo's phantasy and the importance of Freud's slip. The role of the analyst's phantasies in applied psychoanalysis and in the analytic relation.

In his paper on Leonardo, Freud made a slip. Referring to the bird which, according to one of Leonardo's memories, tossed its tail into the painter's mouth many times when he was a child, Freud replaced 'kite' with 'vulture'. It is widely accepted that this slip doesn't significantly damage the whole of Freud's constructions on the paper, nevertheless, the part of his considerations relating to the meaning of 'vulture' should be discounted. In the author's view, this part of the Leonardo paper is necessary. Thanks to the slip Freud was able to reach a comprehension which otherwise would have been unattainable. Interpretation based on the vulture made possible the configuration of a mother as 'daughter of the wind' as was the case not only with Leonardo's mother but also with Freuds. Interpretation of Leonardo's phantasy was achieved through Freud's unconscious identification with Leonardo and the slip adequately interpreted becomes the evidence of this. Through identification, Freud succeeded in making sense of Leonardo's memory but also in realising an indirect virile possession of his own 'winged' mother Freud's position as interpreting subject in his paper on Leonardo also has more general value: the analyst's knowledge about the 'other' has a very important basis in the indirect expression of his unconscious wishes within the field of sense. The author uses clinical material in order to show how the analyst's phantasies play an important role in analytical interpretive work.

Adaptation, Psychological↗
PubMed2002

Lessons from MacGyver: working psychoanalytically under less than optimal conditions.

The author describes a model for working psychoanalytically under less than optimal conditions. Using the television character MacGyver as a metaphor, the author explores challenging situations in which factors related to the patient, setting, and therapist preclude the possibility of conducting a standard analysis. Psychoanalytically informed clinicians need to have a simple, practical model for understanding the psychical world and the importance of the unconscious. In this "search-and-rescue operation," the therapist helps the patient make fresh contact with split-off parts of his or her personality. The main tool used is psychoanalytic understanding, enhanced by analytic listening and the interpretation of the transference. Two clinical cases demonstrate how, even when so many prohibitive factors predominate, deeper contact with the patient's unconscious life and development of the personality can be facilitated.

Adult↗
PubMed2006

The three R's of group: resistance, rebellion, and refusal.

I describe three constellations of group life and group process: resistance, rebellion, and refusal. In resistance, an individual or group remains antagonistic to conscious but not unconscious thinking, the latter manifested in derivatives, including symbol and symptom formation, transference-countertransference, and enactment. Rebellion functions on the level of conscious thinking, manifested in challenge, defiance, and the possibility of sociopolitical action. The basic premises and values of the group and/or leader are at the center of the controversy, to be addressed on that level. Refusal establishes a mental boundary between what is considered appropriate and inappropriate. Unconscious as well as conscious processes of feeling, thinking, and meaning making are refused entry, left undeveloped, rejected, or obstructed. Working with refusal requires appreciating how and why the mind and its thinking operations are being suspended. The theoretical framework is applied to a case example.

Humans↗
PubMed1986

Pregnancy as a reaction to early childhood sibling loss.

Surrogate mothers, illegitimately pregnant teenagers, married women seeking abortions, women convicted of manslaughter, and sister survivors of early childhood sibling loss may share a common conflict. These women may be in a state of incomplete mourning, unconsciously wishing to master a trauma by turning a passive experience into a life event they can control. Pregnancy can function as that life event. Replacement daughters and/or sister survivors can present as our patients with a search for or an avoidance of pregnancy as a crucial though unconscious issue. Literature written about this sequelae of early sibling death is reviewed according to psychosexual and object relationship stages. Common and uncommon consequences are discussed. Vignettes from the course of psychoanalytic therapy with women whose brothers had been accidently killed; whose sibling had died of metabolic disease; and those whose siblings had been relinquished to foster care are used to illustrate the immediate and long-term reactions. The range of these include varieties of separation anxiety as well as learning inhibitions in latency; exaggerated pseudo heterosexuality and other risk taking at puberty; problems in self-esteem regulation relative to either the idealized memory of the missing sibling or the omnipotence connected with survivor guilt. This paper focuses on the choice of a sexual partner and pregnancy issues as symptoms of reworking established conflicts around self-valuation and abandonment by sibling and grieving parents. As the family relationships around the lost sibling become less distorted in her analysis via transference resolution, so do the feelings about contemporary relationships. Becoming pregnant is then not an event burdened by the past.

Adaptation, Psychological↗
PubMed1991

How analytic is psychoanalytic psychotherapy?

This essay attempts to resolve some of the ambiguities regarding the differentiation of psychoanalytic psychotherapy from psychoanalysis. It argues that they result from a failure to recognize that psychotherapy, although it is grounded in psychoanalytic knowledge, is fundamentally different from psychoanalysis in that it does not have as its goal an uncovering of the unconscious and therefore does not use the psychoanalytic method devised for this purpose. Psychotherapy, in this view, is understood as a reality-oriented process that helps a person understand the present in continuity with a consciously accessible past and that promotes the integration of divergent but alternatively conscious aspects of the self and the object. The conceptual framework for psychotherapy thus understood is to be found in developmental psychology, object relations theory, and the psychology of the self. The essentially analytic aspects of such a process reside in the psychoanalytic knowledge of human development that guides our understanding of the clinical material but also the limits of our therapeutic endeavors; in the analytic attitude of openness to the accessible and individual meaning of a patient's communications that guards against imposing cognitively deduced interpretations of supposedly unconscious meanings; and in the engagement of, and respect for, the patient's observing ego.

Freudian Theory↗
PubMed1992

The semiotics of gender.

The semiotics of gender are investigated in this article for the purpose of exploring the way that deep unconscious motives in relationship to cultural biases give rise to gender concepts. Theories of semiotic processes, including Jacques Lacan's concept of the psychoanalytic signifier, are explained briefly and applied to the signs of gender. The article concludes that gender concepts develop out of biology, unconscious feelings, and social patterning, and are not given, natural, and irrevocable.

Cultural Characteristics↗
PubMed1997

Severe hypoglycemia in children with IDDM. A prospective population study, 1992-1994.

OBJECTIVE: Is an increased incidence of severe hypoglycemia an unavoidable effect of improved metabolic control? And, if so, to what extent? RESEARCH DESIGN AND METHODS: In 1992-1994, severe hypoglycemia was prospectively registered in our intensively treated IDDM population, 146 children 1-18 years of age with > 90% of the patients on > or = 4 insulin injections per day. The two categories, "severe hypoglycemia with unconsciousness" (U hypoglycemia) and "severe hypoglycemia without unconsciousness but needing the assistance of another person" (NU hypoglycemia), were analyzed in relation to yearly mean HbAlc levels, insulin doses and proportion of short-acting insulin, age at onset, duration of diabetes, age, sex, and weight-to-height ratio. RESULTS: Yearly mean HbAlc levels improved from 8.1 +/- 1.6% in 1992 to 6.9 +/- 1.3% in 1994. The yearly incidence of U hypoglycemia was 0.15-0.19 events per patient-year, seen in 10-16% of patients, showing no significant increase from 1992-1994. For NU hypoglycemia, slightly increasing figures from 1.01 to 1.26 events per patient-year, seen in 27-38% of patients yearly, were reported. There was no significant correlation between severe (U or NU) hypoglycemia and HbAlc, but still an association was seen in certain calculations. In multiple regression analysis, U hypoglycemia was not related to any factor, but the square root of the rate of NU hypoglycemia was related to lower HbAlc levels (P = 0.0003), higher insulin doses (IU.kg-1.24 h-1) (P = 0.0024), and a lower proportion of short-acting insulin out of the total daily insulin dose (P = 0.031). CONCLUSIONS: Multiple-dose insulin therapy with rather low yearly mean HbAlc values causes a slight increase of NU hypoglycemia but no increase of U hypoglycemia in our population of children with IDDM. Near physiological HbAlc levels may be achieved without any pronounced risk of increasing the incidence of severe hypoglycemia when multiple-injection insulin therapy is combined with adequate self-control based on psychosocial support and active education.

Adolescent↗
PubMed2006

Critique of Sohlberg and Birgegard's (2003) report of persistent complex effects of subliminal psychodynamic activation messages.

Silverman in 1983 held that the unconscious encoding of MOMMY AND I ARE ONE triggers a fantasy of symbiotic union with the good mother of early childhood. In contrast, later Sohlberg and Birgegard contended that MOMMY AND I triggers associations to similarity issues with mother, associations that may be influenced by the words following MOMMY AND I. Although their messages produce, lmost invariably, no reportable sensation, Sohlberg and Birgegard claimed strong evidence for the influence of such messages on perception, motivation, and memory, 10 ays poststimulation and suggestive evidence 4 mo. later. Their findings are not compelling evidence for these claims; and there is no evidence that any result was associated with the unconscious encoding of the psychodynamic meaning of a multiword message.

Adaptation, Psychological↗