bluuebunny/crossref_metadata_2025 huggingface dataset:
Drug Dreams: a Neuropsychoanalytic Hypothesis
Authors: Johnson Brian
Published: April 2008

Recent studies have shown that the ventral tegmental pathway stimulates both dreaming and drug craving. To investigate a possible clinical link between these two psychic phenomena, psychotherapy notes from the first six months of an addicted patient's treatment were reviewed, together with verbatim notes from the four years of psychoanalysis that followed. Of 240 dreams reported by the patient,58 had manifest content involving the seeking or using of drugs. There was no particular temporal or emotional thematic pattern to these “drug dreams,”which persisted through four and a half years of sobriety. Drug dreams are observable phenomena that reflect both the innate structure of the brain and neural changes produced by exposure to addictive drugs. In some addicted persons, exposure to drugs produces a fixed change in neurological functioning with which they must contend for years, possibly the rest of their lives. Drug craving meets Freud's defining characteristics for a drive: it is a constant pressure, originating from within the organism, to do work, and it constantly demands satisfaction. Because ego and libidinal drives share a common neural pathway, they should not be separated conceptually. Solms's finding (in press) that the activating systems for dreaming and for craving are identical, a finding based on observations of tumor- or stroke-provoked brain lesions, is confirmed by observation of the dreams of a patient whose brain changes were created by drug exposure. This study provides further evidence that the origin of the dream is a wish.
The Penn Psychoanalytic Treatment Collection: a Set of Complete and Recorded Psychoanalyses as a Research Resource
Authors: Luborsky Lester , Stuart Jennifer , Friedman Scott , Diguer Louis , Seligman David A. , Bucci Wilma , Pulver Sydney , Krause Elizabeth D. , Ermold Jenna , Davison Walter T. , Woody George , Mergenthaler Erhard
Published: April 2008

From a set of seventeen complete and tape-recorded psychoanalyses, a sample of findings is presented: (a) the level of agreement of two clinical judges on the psychological health of these patients is adequate for the late sessions, but not for the early sessions; (b) the amount of change during psychoanalysis appears to be similar to that in the Menninger Foundation Psychotherapy Research Project; (c) psychiatric severity measures from the early sessions can yield a significant level of prediction of the later benefits from psychoanalysis. Finally, further research uses of this collection of psychoanalyses are suggested.
The Appeal Cycle in Three Cultures: an Exploratory Comparison of Child Development
Authors: Okimoto Joseph T.
Published: April 2008

Mother-child behaviors were studied in three cultural groups: Caucasian American (CA), overseas Japanese (JPN), and Chinese Vietnamese (CVN) immigrants. The children were sixteen to twenty-five months old, and the appeal cycle, with its descriptive analytic method, was the research paradigm. Group differences were found in appeal cycle occurrence and phase frequencies. CA mothers promoted independence through encouragement of decision making and toddler-initiated play, and through nonintrusive interactions. Neither JPN nor CVN mothers encouraged independence. JPN mothers were subtly directive; CVN mothers overtly so. Generally, CA toddlers played independently, evincing a beginning capacity for self-regulation. JPN and CVN toddlers reacted to separation by staying close to their mothers, and fewer were observed to play independently than in the CA group. CVN toddlers played independently more frequently than JPN toddlers, but less frequently than CA toddlers. Quantitative measures of dyadic behaviors generally support the descriptive findings, though methodological constraints did not permit comparison of phase sequencing. The findings reflect cultural differences in child development thought to influence psychic structure formation.
Critical Realism: Distinguishing the Psychological Subjectivity of the Analyst From Epistemological Subjectivism
Authors: Hanly Charles , Fitzpatrick Hanly Margaret Ann
Published: April 2008

To clarify the concepts of critical realism, subjectivity, and subjectivism, distinctions are drawn among ontological subjectivism, moral subjectivity, psychological subjectivity, and epistemological subjectivism. Psychological subjectivity, including the ongoing affective life of the analyst, is an essential aspect of the analyst's response to the patient, and may either facilitate or distort an adequate observation of transference and countertransference dynamics and of the psychic reality of the patient. Subjectivism in current psychoanalytic literature involves an argument that there is an “irreducible” subjectivity in the analyst, who is bound to see things from an incorrigibly personal point of view, such that there is no substantial subject-object differentiation between analyst and patient. Issues of authoritarianism in the analyst, or of pathological certainty, should not be confused with the issues of epistemological objectivism. The concept of critical realism or scientific objectivism includes the essential idea that there is no pure knowledge, no complete knowledge, that often evidence is insufficient for knowledge of some aspect of nature, and that care must be to taken understand what is sufficient knowledge in a given area, in this case clinical psychoanalysis. The question is raised whether “projective identification” makes the sorting out of “what comes from whom” impossible. It is argued that when free association is sufficiently facilitated, when there are enough corrections of the distortions wrought by transference and countertransference, when defenses are analyzed, and when sufficient subject-object differentiation is recovered, the analyst can get to know enough of the patient's psychic reality for the therapeutic and scientific purposes of psychoanalysis.
Narcissism, Eroticism, and Envy in the Supervisory Relationship
Authors: Jacobs Daniel
Published: April 2008

Supervision takes place in a framework of time, place, and duration agreed upon by teacher and student. But beyond the formal arrangements of supervision lie a host of behaviors that express conscious and unconscious fears and wishes that are aroused in student and teacher by their meetings. This paper focuses on supervisors' motivations for teaching, and the ways in which their narcissistic vulnerabilities and their feelings for their students may influence the frame of supervision and its outcome.
Countertransference, Supervised Analysis, and Psychoanalytic Training Requirements
Authors: Jaffe Lee
Published: April 2008

Because psychoanalysts have an ever expanding appreciation for the many factors that contribute to the psychoanalytic treatment process, they no longer view themselves simply as the receiver of the patient's transferences. When patient and analyst meet in the consulting room, they bring along with them a blend of intrapsychic and external ingredients— including countertransference—that make up the analytic soup. Candidates in psychoanalytic training must contend with even more sources of indirect countertransference reactions (Racker 1968) than experienced graduate analysts, due to aspects of the training experience itself.The author contends that minimum graduation requirements for supervised analyses are one such source of indirect countertransference. Four clinical examples of control analyses demonstrate this form of indirect countertransference during the assessment, opening, middle, and termination phases. These examples are followed by implications and recommendations for didactic psychoanalytic training curricula, countertransference awareness, supervision of control cases, institute governance policies and procedures, publication of clinical material, and future research.
Normal and Pathological Altruism
Authors: Seelig Beth J. , Rosof Lisa S.
Published: April 2008

The psychoanalytic literature on altruism is sparse, although much has been written on this topic from a sociobiological perspective. Freud (1917) first described the concept in “Libido Theory and Narcissism.” In 1946 Anna Freud coined the term “altruistic surrender” to describe the psychodynamics of altruistic behavior in a group of inhibited individuals who were neurotically driven to do good for others. The usefulness and clinical applicability of this formulation, in conjunction with the frequent coexistence of masochism and altruism, encouraged psychoanalysts to regard all forms of altruism as having masochistic underpinnings. Since then, there has been a conflation of the two concepts in much of the analytic literature. This paper reexamines the psychoanalytic understanding of altruism and proposes an expansion of the concept to include a normal form. Five types of altruism are described: protoaltruism, generative altruism, conflicted altruism, pseudoaltruism, and psychotic altruism. Protoaltruism has biological roots and can be observed in animals. In humans, protoaltruism includes maternal and paternal nurturing and protectiveness. Generative altruism is the nonconflictual pleasure in fostering the success and/or welfare of another. Conflicted altruism is generative altruism that is drawn into conflict, but in which the pleasure and satisfaction of another (a proxy) is actually enjoyed. Pseudoaltruism originates in conflict and serves as a defensive cloak for underlying sadomasochism. Psychotic altruism is defined as the sometimes bizarre forms of caretaking behavior and associated self-denial seen in psychotic individuals, and often based on delusion. We consider Anna Freud's altruistic surrender to combine features of both conflict-laden altruism and pseudoaltruism. Two clinical illustrations are discussed.
On Hating in the First Person Plural: Thinking Psychoanalytically About Racism, Homophobia, and Misogyny
Authors: Moss Donald
Published: April 2008

On the basis of personal, cultural, and clinical references, misogyny, homophobia, and racism are conceptualized as structured forms of hatred grounded in a defensive use of the first person plural voice. This use of hatred defends against dangers associated with desires linked to the first person singular. In these hatreds, “I want” is defensively transformed into “we hate.” Disidentification from and hatred of the object appear where identification and yearning had been. Along with this defensive move into plurality, with these forms of hatred comes the use of what is conceptualized as the “hermeneutics of transparency.” Here the hated qualities of the objects in question are sensed to be transparently obvious, a matter not of thought but of perception. The underlying premises of these hatreds are then contrasted with the underlying premises of psychoanalysis. Effective psychoanalytic work with these hatreds entails resisting the moral pressure to disidentify from them, while bearing the often profound discomfort linked with identifying with them.
Psychoanalytic Patients in the U.S., Canada, and Australia: I. DSM-III-R Disorders, Indications, Previous Treatment, Medications, and Length of Treatment
Authors: Doidge Norman , Simon Barry , Brauer Lee , Grant Donald C. , First Michael , Brunshaw Jacqueline , Lancee William J. , Stevens Annette , Oldham John M. , Mosher Paul
Published: April 2008

To determine the demographics, DSM-III-R disorders diagnosed, indications used in recommending psychoanalysis, previous treatment histories, use of medication, and length of treatment in patients in psychoanalysis in the U.S., Canada, and Australia, a mail survey of practice was sent to every other active member of the American Psychoanalytic Association and every member of the Australian Psychoanalytical Society. This supplemented an earlier survey sent to all Ontario psychoanalysts. The response rates were 40.1 % (n=342) for the U.S., 67.2% (n=117) for Canada, and 73.9% (n=51) for Australia. Respondents supplied data on 1,718 patients. The employment rate for patients increases as analysis progresses ( p < .0001). The mean number of concurrent categories of disorders (Axis I, Axis II, and Disorders First Evident in Childhood) per patient at the start of treatment is 5.01 (SD=3.66; median=4; mode=3). There are no statistically significant differences across countries. Mood, anxiety, sexual dysfunction, and personality disorders are most common. American Psychiatric Association / American Psychoanalytic Association peer review criteria for indicating psychoanalysis are followed for 86.5% of patients. Over 80% of patients in all three countries had undergone previous treatments prior to analysis. In the U.S., 18.2% of analysands are on concurrent psychoactive medication; in Australia, 9.6%. The mean length of analyses conducted in the U.S. is 5.7 years, in Australia 6.6, and in Canada 4.8. Psychoanalytic patients in all three countries have similar rates of DSM-III-R psychopathology, and many indications of chronicity.
The Termination Phase of Psychoanalysis as Seen Through the Lens of the Dream
Authors: Grenell Gary
Published: April 2008

The decision about when to terminate analysis has long been underpinned by a theory-driven criterion model, which may steer the analytic dialogue away from its customary activities of free association, empathic listening, and interpretation. As a remedy to this situation, the author proposes that by paying careful attention to less consciously crafted patient communications such as dreams, the analytic dyad can consider readiness to set a termination date from a perspective that is context-sensitive and less encumbered by preordained criteria. Tracing the dreams of one analysand from the vantage point of contemporary dream theory, the author demonstrates how careful attention to the dream elucidated the patient's readiness to terminate and her complex feelings about the termination process. Finally, the author challenges the notion that the termination phase is of greater evaluative than therapeutic importance, and provides clinical material as evidence that this is not the case.
Freud's Writing: His (W)Rite of Passage and Its Reverberations
Authors: Mahony Patrick
Published: April 2008

The study of Freud's personal conception of writing and his use of it illuminates a significant aspect of his relationship with others, and also his sense of his own heroic greatness. In two related periods of his life, acts of writing—which were notably overdetermined in Freud and which informed as well as facilitated a distinctive kind of selfexpression—gave rise to veritable (w)rites of passage. In those periods, the transferential dynamics in Freud's relationships with Fliess, his daughter Anna, and certain important analysands were expressed in ways connected with the content and process of various types of writing, including editing and translating. In sum, there is something still to be discovered in Freud's attitudes to his writing and to related intergenerational transactions between analysts and analysands who engage together in compositional activities.
Magic and the Aesthetic Illusion
Authors: Balter Leon
Published: April 2008

The aesthetic illusion is the subjective experience that the content of a work of art is reality. It has an intrinsic relation to magic, an intrapsychic maneuver oriented toward modification and control of the extraspyschic world, principally through ego functioning. Magic is ontogenetically and culturally archaic, expresses the omnipotence inherent in primary narcissism, and operates according to the logic of the primary process. Magic is a constituent of all ego functioning, usually latent in later development. It may persist as an archaic feature or may be evoked regressively in global or circumscribed ways. It causes a general disinhibition of instincts and impulses attended by a sense of confidence, exhiliration, and exuberance. The aesthetic illusion is a combination of illusions: (1) that the daydream embodied by the work of art is the beholder's own, the artist being ignored, and (2) that the artistically described protagonist is a real person with a real “world.” The first illusion arises through the beholder's emotional-instinctual gratification from his or her own fantasy-memory constellations; the second comes about because the beholder, by taking the protagonist as proxy, mobilizes the subjective experience of the imaginary protagonist's `reality.` The first illusion is necessary for the second to take place; the second establishes the aesthetic illusion proper. Both illusions are instances of magic. Accordingly, the aesthetic illusion is accompanied by a heady experience of excitement and euphoria. The relation among the aesthetic illusion, magic, and enthusiasm is illustrated by an analytic case, J. D. Salinger's `The Laughing Man,` Woody Allen's Play It Again, Sam, Don Quixote, and the medieval Cult of the Saints.
Flaubert and Madame Bovary: An Intimate Courtship
Authors: Baudry Francis
Published: April 2008

The process by which Gustave Flaubert created the character of Emma Bovary is examined, as are various of the author's sources for the heroine and their transformation in the course of composing the novel. Certain aspects of the author's psychic makeup, including his bisexuality, are discussed in this light, as are Flaubert's early traumatic losses and their influence on his way of working. Finally, it is suggested that writing had multiple functions for the author and that the creation of Emma Bovary served as a partial solution to unmet needs.
Andrea Del Sarto Rehabilitated: A Psychoanalytic Emendation
Authors: Trosman Harry
Published: April 2008

Ernest Jones's “The Influence of Andrea del Sarto's Wife on His Art” (1913) is an early example of psychoanalysis applied to the study of a prominent painter. Greatly influenced by Freud's Leonardo da Vinci and a Memory of His Childhood, Jones gave excessive credence to Vasari's highly prejudicial account of the life of del Sarto, on which the study relied heavily. Jones attempted to account psychologically for the circumstance that del Sarto, though highly skilled and “faultless,” was not the equal of the three preeminent masters of the Italian High Renaissance: Leonardo, Michelangelo, and Raphael. Jones's uncritical acceptance of the Vasari biography encouraged him to view del Sarto's assumed deficiency as the result of excessive attachment to his wife, a pathological uxoriousness. A contemporary psychoanalytic perspective, with its emphasis on the emotive response of the analyst, requires us to pay attention to the evocative nature of the work of the artist, an approach Jones neglected. In an examination of several paintings, the artist's sensitivity to the position of the spectator is explored, as is the interest in involving the viewer spatially and emotionally. An appreciation for the viewer's position is consistent with a capacity for using projected internal objects for creative purposes. The presence of this capacity suggests a revised view of del Sarto's contribution to art and of his relationship with his wife.
Silent Thoughts, Spoken Wishes: When Candidate Experience of the Supervisor Converges With Patient Fantasies
Authors: Barron Grace Caroline
Published: April 2008

How and why a candidate's private experience of two supervisors emerged in patients' fantasies about them is explored. Four issues are examined in light of two control cases: (1) Patients divide, rather than split, the transference between supervisor and candidate, experiencing both ambivalently. (2) Even a patient with no knowledge of the supervisor's identity may have a fantasy of the supervisor that is congruent with the candidate's experience of the supervisor. (3) When new professional traits emerge in the candidate as he or she identifies with his or her mentor, the patient may attribute them to the invisible person in the room—the supervisor; the patient may intuit and be influenced by the candidate's feelings about the supervisor as well. (4) A patient's fantasies about the supervisor may reflect parallel process in reverse, whereby the patient discerns what is going on between supervisor and candidate through his or her treatment, just as the supervisor reads what is going on between patient and candidate through the candidate's reporting of the treatment. Because the trio is the truth of the training case, it seems fitting and empowering to acknowledge and analyze the role of the supervisor in the patient's mind.
The Course of 253 Analyses from Selection to Outcome
Authors: Erle Joan B. , Goldberg Daniel A.
Published: April 2008

Two studies of the clinical work of experienced psychoanalysts are presented. Study I is a retrospective study of all the analytic work—161 cases—of sixteen analysts from l973 to l977, including their evaluations of the treatments at outcome. Study II is a prospective study of the ninety-two cases started in analysis by a group of twenty analysts between 1984 and l989 and followed to termination, including their reports. The history of each treatment as reported and evaluated by the analyst is examined in terms of: nature of the population, the analyst's view of the case when the initial recommendation was made, duration of treatment, therapeutic benefit, rating of analyzability at termination of treatment, nature of the termination, and cases changed to psychotherapy. Some old shibboleths are challenged as perspective on both the limitations and achievements of psychoanalysis emerges from the findings of the study.
Change in Psychoanalysis: Getting From A to B
Authors: Harrison Alexandra M.
Published: April 2008

The change that occurred during an analytic hour with a seven-year-old girl is explored by means of videotape observation and aspects of developmental theory drawn from the field of infant research. Detailed review of the videotape and transcript of twelve minutes of the analytic hour revealed significant change in the girl's attitude toward the loss represented by a cancelled session. The moment-to-moment process between two points, A and B—identified as representing the beginning and end of the change in the girl's ability to deal with loss in the analytic relationship—is studied and described in two forms: written transcript for the verbal material, and narrative description for the nonverbal material. The methodology is based on observed behaviors but also relies on the clinical experience of the analyst in the interpretation of affects and the recognition of intentions in both participants. The results suggest that, taken as a whole, many such small transitional episodes during the course of a treatment play an important role in the process of therapeutic change.
Psychic Trauma and Traumatic Object Loss
Authors: Blum Harold P.
Published: April 2008

Psychoanalysis began with the concept of psychic trauma, which was subsequently not clearly differentiated from traumatic object loss or from unconscious conflict and fantasy. Psychic trauma is investigated in relation to unconscious conflict, with and without concurrent object loss. The syndromes of PTSD, uncomplicated by object loss, of traumatic bereavement, and of relatively nontraumatic bereavement, though often interwoven and inseparable, are all different. The significance of the loss, sociocultural factors, and group process influence individual responses to trauma and traumatic bereavement. There are specific neurobiological and psychological sequelae of traumatic experience. Clinical applications are noted.
Identity Maintenance in the Affectively Distant Patient
Authors: Hoffman Irwin
Published: April 2008

Patients who are affectively distant, in that they appear to have little conscious emotional investment in the analyst, have been described increasingly in the psychoanalytic literature of the last twenty years. Typically, they have been understood either from a developmental point of view as defensively struggling against wishes for symbiotic union or, on the Kleinian model, as having unconscious fantasies of bodily fusion with the mother that, upon separation from her, result in annihilation anxiety that generates autistic defenses. Of special importance is the work of Heinz Lichtenstein, who stresses early identity maintenance and the role of mirroring experiences with the mother in the development of an “identity theme.” This concept is used here as a symbiotic precursor of ego identity that ties the self to a particular mother. It is this primitive form of identity that can occasion regressive self-definition in the transference of the affectively distant patient. Two cases are presented that illustrate dynamics and transference dispositions occurring in the psychoanalysis of these patients. The discussion focuses on the role of the patient's catastrophic fear of acceptance, as well as on the consequent need for self-protective measures. It is argued that careful and consistent analysis of these conflicted areas of these patients' transference leads toward greater integration of their identity and personality.
The Emerging Dialogue Between Psychoanalysis and Neuroscience: Neuroimaging Perspectives
Authors: Beutel Manfred E. , Stern Emily , Silbersweig David A.
Published: April 2008

Current progress in the cognitive neurosciences is highly relevant to the development of psychoanalytic theory and practice. Neuroscience is today becoming mature enough to provide empirical biological approaches for the investigation of psychoanalytic models and observations. The current state of functional neuroimaging techniques is reviewed, selected paradigms and findings relevant to psychotherapy research are presented, and ways to pursue the dialogue between psychoanalysts and neuroscientists are discussed, as are some related obstacles and pitfalls. The emerging dialogue between psychoanalysts and neuroscientists may help not only to reestablish a solid position of psychodynamic theory and treatment in contemporary medicine, but also to bridge the division between “psychological” and “somatic” treatments, and gain important insights into the mind-brain relationship.
Dissociation and the Parent-Infant Dialogue: a Longitudinal Perspective From Attachment Research
Authors: Lyons-Ruth Karlen
Published: April 2008

Two longitudinal attachment studies of families at social risk have now followed their cohorts of infants to late adolescence. Several key findings have emerged related to outcomes of interest to psychoanalysts. First, data from both studies indicate that disorganized attachment behaviors in infancy are important precursors of later dissociative symptomatology. Second, this early vulnerability is related to patterns of parent-infant affective communication, particularly quieter behaviors like emotional unavailability or role reversal, and does not appear to reside in the infant alone. Finally, the results suggest that the quality of the attachment relationship may in part account for why some people exposed to later trauma develop dissociative symptoms and others do not. To paraphrase Dori Laub (1993), the mother's seeing and not knowing in infancy may be a precondition of her child's knowing and not knowing in late adolescence. It remains unclear, however, whether the early relationship is predictive due primarily to the onset of an internal defensive process in infancy or whether its predictive power resides primarily in enduring patterns of parent-child dialogue that continually reinforce the child's segregated and contradictory mental contents.
On the Question of the Patient's rIght To Tell and the Ethical Reality of Psychoanalysis
Authors: Blass Rachel B.
Published: April 2008

This paper calls into question the view that it is ethically legitimate for the patient to say whatever comes to his or her mind: that is, to adhere to the fundamental rule. While there have been some variations in the application of this rule since Freud's time, it remains for many the bedrock of clinical practice, and the patient's right to free-associate has never been questioned. Recent debates on the importance of the analyst's strict confidentiality have highlighted this right. Ethical problems raised by adherence to the fundamental rule are explored through an examination of the general ethical limitations on what one may say to another person, and the special features of the analytic relationship that seem to do away with these limitations. The fact that there are ethical questions about adherence to the fundamental rule draws attention to what the author calls the ethical reality of psychoanalysis. The recognition of this reality has implications for the understanding and handling of ethical dilemmas regarding disclosure, as well as for other ethical issues that may arise in the course of an analysis.
Mothers' Ambivalence With Their Babies and Toddlers: Manifestations of Conflicts With Aggression
Authors: Hoffman Leon
Published: April 2008

In this paper the author continues his study of conflicts over aggression in women, discussing the implications for contemporary theories of feminine psychology of observations of mothers in parent/child groups with their infants and toddlers. Many mothers experience conflicts over aggression (both in themselves and in their children) and become intolerant of their ambivalence toward their children. The author suggests that this observation provides an avenue that allows an integration of psychoanalytic ideas about maternity and childrearing with psychoanalytic understandings of women's conflicts about achievement in the social realm outside the home. In both roles, difficulties mastering conflicts with aggression may cause women to struggle profoundly, and to experience problems, in successfully negotiating their important life goals, whether the goals refer to their roles as effective mothers or their roles as effective individuals in the social sphere outside the home. Some women may demonstrate these difficulties in one sphere or the other, some in both, and others in neither. The author suggests on the one hand that we need to eliminate the concept of normality when considering the activities of women, and on the other hand that we need to normalize the omnipresence of ambivalence in the psychology of women.
The Femininization of the Female Oedipal Complex, Part Ii: Aggression Reconsidered
Authors: Holtzman Deanna , Kulish Nancy
Published: April 2008

This paper examines and explores the manifestations of aggressive impulses in the so-called female oedipal complex. The authors describe how competitive aggression on the part of young girls, seemingly missing in children's stories and myths, is unconsciously inhibited, disguised, or externalized. They report similar phenomena in women patients involved in triangular conflicts, and present a selected review of the literature on the inhibition of aggression within the female triangular situation. Stressing dynamic patterns in the object relationships in the female triangular situation, the authors offer a psychological explanation for this inhibition. They present clinical material to demonstrate how overt murderous and competitive aggression toward the mother appears after considerable analytic work. They conclude that girls and women frequently relinquish a sense of agency over both aggression and sexuality in dealing with triangular conflicts, to preserve a safe relationship with their mothers.
Cyclones, Bi-Cycles, and Psychoanalysis: the Witch-of-Us? Complex and the Wizard of Oz
Authors: Stern Jeffrey
Published: April 2008

Works of applied psychoanalysis normally use psychoanalytic theory to reveal the secret meanings of works of art. An attempt is made to reverse the directionality of such analyses and see whether a work of art, The Wizard of Oz, has something to teach psychoanalysis about adolescent female psychosexual development. The author argues that the popularity and importance of the film is an effect of its symbolic representation of a girl's entry into menarche, and the meaning of this milestone for herself and for her mother. He addresses ideas about feminine castration fears (or what more recently have been called fears of genital injury), issues about menopause, and fantasies—both surprising and violent— around the meanings of menarche for both mother and daughter.
Does the Mind Fall Apart in Multiple Personality Disorder? Some Proposals Based On a Psychoanalytic Case
Authors: Gottlieb Richard M.
Published: April 2008

A psychoanalytic study of some of the phenomena of multiple personality disorder (MPD), this paper takes issue with the view that a falling apart, fragmentation, or disaggregation of the mind is at the bottom of MPD's characteristic symptoms. Since first proposed by Janet in 1889, the view that ordinarily integrated parts of the mind separate from the center, accounting for the appearance of separate “selves,” has prevailed among workers in this field. The close psychoanalytic study of a case of MPD suggests that, to the contrary, the appearance of multiplicity may derive from an essentially unitary but nonetheless powerful set of organizing fantasies centering on the idea that one's body and mind can be taken over and controlled by persons other than oneself. The data of the case under study suggest, further, that certain of the details of these patients' histories of childhood sexual and physical abuse may be of great importance in explaining the extraordinary organizing power of their fantasies of being occupied and controlled. In this connection, special attention is directed to the very commonly reported experiences of forced violation and the involuntary filling and emptying of their bodies during childhood.
The Art and Science of Dream Interpretation: Isakower Revisited
Authors: Reiser Morton F.
Published: April 2008

Dream imagery presents a special opportunity to lead patient and analyst through the patient's network of memories to the discovery of unconscious memories that have complicated and interfered with the patient's attempts to resolve important life problems. This is an important, perhaps indispensable, first step on the way to successful working through to solutions that are more rational and realistic than the neurotic symptoms that brought the patient to treatment in the first place. Theoretical and empirical rationales are presented for a technical approach to dreams that takes full advantage of the special opportunities that working with dream imagery provides: for deepening the psychoanalytic process and for acquainting the patient with principles of mental function applicable to aspects and phases of the analytic process that he/she will encounter as the work progresses.
An Investigation of Anxious Thought in Patients With Dsm-Iv Agoraphobia / Panic Disorder: Rationale and Design
Authors: Compton Allan
Published: April 2008

Psychoanalysis as a profession is in difficulty because changes in the mental health field have exposed vulnerabilities inherent in psychoanalytic traditions. In this setting, scientific outcome studies of psychoanalytic treatment are a necessity. To enable such studies, certain preliminary research is required. In particular, a set of reliable diagnoses that recognize psychodynamic factors, in addition to “descriptive” criteria, must be developed. This paper outlines the rationale, significance, and design of a pilot study in the area of anxiety disorders, agoraphobia in particular, intended to provide a basis for recategorization of the currently predominant DSM system.
Aggression: Its Relation To Desire and Self-Interest
Authors: Raphling David L.
Published: April 2008

Aggression continues to be a problematic, ill-defined concept for most contemporary analysts. Questions about the nature and origin of aggression remain unanswered. On the one hand, aggression is conceived of as an instinctual drive; on the other, it is thought to originate as an instrument of reaction to external sources of frustration and environmental failures to meet developmental needs. Aggression has also been dichotomized as either the benign activity of assertiveness, or the darker destructive force of hostility, believed by many to arise from separate motivational systems. There is a problem with the view of aggression as largely an ad hoc reaction to deprivation or other environmental shortcomings leading to disappointment and frustration. This view understates the importance of the original expansive demands for pleasurable satisfaction made by the individual upon the environment. Desire itself seems to be responsible for an inward vulnerability to external sources of disappointment and frustration, so that what is not desired cannot be effectively frustrated. Though the prototypical object of aggression is taken to be an external source of frustration, danger, and narcissistic injury, the mobilization of aggression more accurately reflects a susceptibility to the disturbing pressure of psychic stimuli that are the inner desire for satisfaction. Aggression contributes its force to various constructive or destructive purposes, from love to mastery to vengeance. Its most immediate aims, primarily narcissistic, are not concerned with the needs of others. Aggression also makes important contributions to maintaining psychic equilibrium, to the psychic organization's stake in instinctual gratification, to ego function, and to superego operation.
Once More Onto the Couch: Consciousness and Preconscious Defenses in Psychoanalysis
Authors: Munder Ross John
Published: April 2008

Use of the couch in the analytic situation has a unique impact on the consciousness of both participants in the process. The hypnagogic state of the supine analysand and its resonance with the empathic reverie of the unseen analyst are explored, with a focus not on the contents of analysts' countertransferential associations, but on the diverse but converging modes in which they represent their patients' verbal productions. A clinical example is presented to illustrate the interplay between the patient's and the analyst's imaginations, an understanding of which does away with the false dichotomy between defense analysis and empathic responsiveness. The importance of a patient's conscious and preconscious defenses in the here-and-now transference (suppression, “marginalization,” disavowal, negation) is also noted, as is the relation of these defenses to unconscious secondary repression.
Memory, Empathy, and Interactive Dimensions of Psychoanalytic Process
Authors: Reiser Morton F.
Published: April 2008

How is psychoanalysis to deal with its ever widening field of clinical observations and the changing theoretical perspectives that may accompany them—e.g., those concerning intersubjectivity and empathy? Will it be necessary, as some suggest, to modify traditional theory and to abandon related principles of technique such as anonymity and abstinence? Detailed clinical examples of specific interactions are presented to illustrate the interrelated roles of memory, subjective interaction, and empathy. It is suggested that these clinical observations, which encompass newer perspectives, do not require new paradigms. Rather, they can for the present be comfortably accommodated within the purview of older observations, modern cognitive neuroscience, and traditional technical theory.
Modern Ego Psychology
Authors: Marcus Eric R.
Published: April 2008

This paper reviews the history of ego psychology, describing problems in the theory that have perhaps contributed to subsequent theory development and theoretical splintering. The present status of ego psychology is then described, with a focus on broadly accepted general principles. A proposal/prediction is then made regarding efforts to integrate the main schools and splinter groups. It is argued that the ego's method of synthesizing aspects of experience will help integrate divergent metapsychological viewpoints.
Leading Change with the 5-P Model
Authors: Ford Robert , Heisler William , Mccreary William
Published: April 2008

An effective change process must account for all aspects related to that change. This article presents a “5-P” framework for implementing change and illustrates the application of the framework with a case situation in which the operations at the Swan and Dolphin Hotels at Walt Disney World were consolidated. The five “P”s are as follows: purpose, priorities, people, process, and proof. Briefly put, change should have a stated purpose; specific targets of change should be identified and prioritized; people potentially affected by the change should be identified and brought into the change process; the process should use appropriate levels of direction, participation, and consultation; and the proof should demonstrate visibly and believably what the change accomplished. While the Swan-Dolphin complexing was not without bumps along the way, the approach resulted in a successful change implementation that saved $4 million in annual expenses.
Outcome Status of Students With Learning Disabilities at Ages 21 and 24
Authors: Seo Young , Abbott Robert D. , Hawkins J. David
Published: April 2008

This study investigated whether the presence of learning disabilities (LD) at age 10 was related to later schooling, employment, income, receipt of public aid, involvement in crime, and feeling of victimization at ages 21 and 24. Confidential self-report data were collected in a prospective, longitudinal panel study from a sample of 571 students, of whom 60 (10.5%) were children with LD. After controlling for gender, ethnicity, and socioeconomic status, the following results were obtained: The highest postsecondary school attainment for young adults with LD was not significantly different from that of their peers without LD, both at age 21 and age 24. The rate of employment and amount of earned income of young adults with LD were not significantly lower than those of their peers without LD both at age 21 and age 24. Young adults with LD were not significantly different from their peers without LD at age 21 and age 24 with respect to having children, but young adults with LD received significantly more public aid (such as food stamps, supplemental security income, and unemployment compensation) at age 21 but not at age 24. Young adults with LD were not significantly different from their peers without LD in committing crimes or feeling victimized at age 21 and age 24.
Correlates of Leisure-Time Physical Activity in Korean Immigrant Women
Authors: Choi JiWon , Wilbur JoEllen , Miller Arlene , Szalacha Laura , McAuley Edward
Published: April 2008

This study describes the physical activity behavior of Korean immigrant women and examines the relationships among leisure-time physical activity (LTPA) behavior, background, and intrapersonal correlates of behavior in Korean immigrant women in the United States using a cross-sectional survey design. A convenience sample of Midwestern Korean immigrant women completed the long form of the International Physical Activity Questionnaire in Korean. Among the participants, 78% were physically active, meeting the Healthy People 2010 goal for physical activity when all physical activity behaviors were considered, whereas 23% met the goal when only LTPA was considered. Women who were older, did not have a child younger than 5, used environmental resources for physical activity, had lower depressive symptoms, and had higher confidence for overcoming exercise barriers were spent more time in LTPA. Accommodating those with young children, enhancing environmental resource use, and improving exercise self-efficacy are important considerations for interventions aimed at increasing LTPA in Korean immigrant women.
Revision Surgery for Failed Elbow Medial Collateral Ligament Reconstruction
Authors: Dines Joshua S. , Yocum Lewis A. , Frank Joshua B. , Attrache Neal S. El , Gambardella Ralph A. , Jobe Frank W.
Published: April 2008

Background

Although excellent results can be achieved in up to 90% of primary elbow medial ulnar collateral ligament reconstructions, retears of the ligament have been reported. As the number of primary reconstructions continues to increase, one could expect a commensurate increase in the number of revision medial collateral ligament reconstructions performed.

Hypothesis

Given the difficulty associated with revision procedures, the complication rate relative to primary reconstructions would increase while the percentage of athletes returning to their previous level of play would decrease.

Study Design

Case series; Level of evidence. 4.

Methods

This was a retrospective review of 15 patients who underwent revision surgery for retear of a reconstructed elbow medial collateral ligament. All patients had undergone previous elbow medial collateral ligament reconstruction and had new history and physical examination findings consistent with medial collateral ligament injury. Twelve subjects were professional baseball players and 3 were college-level players at the time of their revision procedure. Patients were evaluated at a minimum of 2 years after revision surgery. Outcomes were classified using the Conway scale.

Results

Average time to revision was 36 months. The technique used in the revision was the Jobe technique in 11 cases, DANE TJ in 3, and primary repair in 1. Thirty-three percent (5/15 excellent) returned to their previous level of play for at least 1 season. Additionally, there were 4 good, 2 fair, and 4 poor results. The ligament repair had a good outcome. Forty percent (6/15) of Patients had complications, 1 of whom required a subsequent surgery (lysis of adhesions). One subject experienced a retear of the medial collateral ligament.

Conclusion

The rate of return to play after revision medial collateral ligament surgery is much lower than after primary reconstruction. As was expected, the complication rate of revision surgery is higher as well. This study should help physicians when counseling baseball players who suffer retears of their medial collateral ligament.
Primary Repair of Ulnar Collateral Ligament Injuries of the Elbow in Young Athletes
Authors: Savoie Felix H. , Trenhaile Scott W. , Roberts John , Field Larry D. , Ramsey J. Randall
Published: April 2008

Background

Little data exist regarding the treatment of young high school and college athletes with medial ulnar collateral ligament insufficiency of the elbow. It would be logical to assume that younger patients would have less damage to the ligament, allowing the possibility of repair.

Hypothesis

Many young athletes with injuries to the medial ulnar collateral ligament have proximal or distal injuries that may be amenable to repair, indicating that graft reconstruction may not always be necessary to obtain satisfactory results.

Study Design

Case series; Level of evidence, 4.

Methods

Sixty patients who had direct repair of the medial ulnar collateral ligament were retrospectively evaluated using the Andrews and Carson elbow score. All patients had symptomatic instability that precluded them from participation in their desired sports, all failed a nonoperative treatment program, and all had comparative stress radiographs, magnetic resonance images, or computerized tomograms with contrast studies that had positive findings for insufficiency of the ligament.

Results

The mean age of the 47 male and 13 female patients was 17.2 years. The mean follow-up was 59.2 months. All patients underwent medial ulnar collateral ligament repair by one of the following procedures: suture plication with repair to bone drill holes (n = 9) or suture repair to bone using anchors (n = 51). The mean overall preoperative Andrews-Carson outcome score of 132 improved to 188 postoperatively ( P < .0001). Good-to-excellent overall results were obtained in 93% of patients. Fifty-eight of the 60 patients were able to return to sports within 6 months of the surgery at the same or higher level as before the injury. There were 4 failures, 2 early and 2 late (after return to play for 5 and 6 years of unrestricted play, respectively). Three patients sustained a complication of transient postoperative ulnar neuropathy symptoms that resolved spontaneously.

Conclusion

Primary repair of proximal and distal injuries of the medial ulnar collateral ligament is a viable alternative in the nonprofessional athlete. Graft reconstructions may not be necessary to obtain favorable outcomes and rapid return to sports in nonprofessional athletes who require surgical intervention for medial elbow instability.