bluuebunny/crossref_metadata_2025 huggingface dataset:
The Case History
Authors: Michels Robert
Published: April 2008

Case histories report the basic data of psychoanalysis, and yet they are strikingly infrequent in the psychoanalytic literature. This reflects not only the methodological problems in describing psychoanalytic cases, but also the complex intentions of psychoanalysts who want both to present and to conceal aspects of their work. The history of the case history is discussed, as are the nature and purpose of case reports, the differences between oral and written reports, the relation between case reports and psychoanalyses, and case reports as countertransferential enactments. A plea is made for including authorial intention as an explicit part of the report, rather than concealing it behind a scientific facade.
A Semiotic Model of Mind
Authors: Olds David D.
Published: April 2008

A theory of signs is presented to arrive at a model of mind that provides a smooth transition from inanimate matter to the thinking brain. Principles of information theory and semiotics are invoked to create a conceptual scheme that can contribute to an understanding of the “mind-body problem.” The thesis is pursued that in living systems, as opposed to inorganic ones, there occurs the phenomenon of semiotic transmission of information. The result is a “dualistic-materialist” position; the dualism arises from the fact that at the beginning of life a set of processes comes into being different from those of the inorganic world. This model has implications for psychology and psychoanalysis. It allows for semiotic systems at different levels—e.g., the molecular, the neural network, the language system, and higher mental functions—to be integrated. Analytic concepts such as free association, clinical technique, feedback systems, personality structure, transference, and repetition compulsions can be understood in both biological and semiotic terms. This model interdigitates with linguistic studies already done in psychoanalysis, as well as with biological models extrinsic to the field.
On Writing From Clinical Experience
Authors: Scharff Jill Savege
Published: April 2008

Papers that present the life of the analytic session offer material through which analysts can together study analytic process and therapeutic action and arrive at consensus on how to improve psychoanalytic theory and practice. But some analysts have been deterred from publishing clinical material of that kind because of concerns about preserving confidentiality, protecting the therapeutic relationship, reporting accurately, being scrutinized, worrying about losing their colleagues' support, and not feeling authorized to present their views. Here conscious, preconscious, and unconscious constraints against writing and publishing are explored, and an example is given of successful self-analysis of a writing inhibition. The debate over the ethics of writing is reviewed and an argument made that detailed clinical description is useful in advancing analytic understanding. Finally, a clinical example shows how the analysand usefully analyzes the experience of reading what the analyst has written, and how the analyst's self-analysis may be promoted in resonance with the analysand's experience.
Suggestion and Psychoanalytic Technique
Authors: Levy Steven T. , Inderbitzin Lawrence B.
Published: April 2008

The role of the analyst's suggestive influence on the course and outcome of psychoanalytic treatment is explored, and traditional and newer perspectives on analytic technique are contrasted. The intersubjective critique of the neutral, objective analyst in relation to suggestion is examined. The inevitable presence and need for suggestive factors in analysis, and the relationship of suggestion to transference susceptibility, are emphasized. The manner in which the analysis of suggestive factors is subsumed in transference analysis as part of traditional technique is highlighted.
Future and Potentiality in the Psychoanalytic Process
Authors: Schou Peter
Published: April 2008

A perspective is delineated on the dimension of the future in the psychoanalytic situation. Clinical manifestations are presented of the tension between actuality and potentiality that characterizes the treatment situation. This tension, an aspect of the intersubjective field that exists between patient and analyst, involves the analyst's hopes, expectations, anticipations, sense of purpose, and therapeutic intent, facets of the analyst's subjectivity that affect the clinical process. The question of the patient's individuality and autonomy is raised in the context of the notion of the “true self.” To understand potentiality in the clinical situation, it is argued, the intersubjective emphasis on the inevitable mutual influence between analyst and patient must be complemented by a view of the self as emerging from within and gaining coherence through the unfolding of inherent dispositions and potentialities.
Patient-Therapist Match: Revelation or Resistance?
Authors: Vaughan Susan C. , Roose Steven P.
Published: April 2008

Patient-therapist match is a relatively new yet frequently invoked concept within psychoanalysis. Despite Freud's appreciation of the influence of the analyst's past to his or her work within the analytic setting, psychoanalysts have historically held varied opinions about the degree to which the analyst's personality and conflicts affect the analytic process. As analysis was reconfigured as a two-person system, attention focused on the fit between patient and analyst. The literature on patient-therapist match is reviewed, and the conclusion reached that this intuitively appealing concept suffers from a lack of rigorous definition and operationalization. Many authors invoke match in ways that imply that it is real, static, external to the domain of analytic inquiry, and unaffected by analytic process. In its present form, the concept of patient-therapist match obstructs rather than facilitates analytic exploration and obscures rather than clarifies what happens between analyst and analysand in psychoanalysis. By suggesting that match exists as a reality outside the domain of transference and countertransference, analysts may overlook the importance of psychoanalytic technique in creating a sense of match. Analysts may attribute stalemated or limited analyses to a bad match, rather than tenaciously exploring the transference-countertransference configurations that remain at the heart of analytic work.
Countertransference Enactments Informed By Cancer in an Analyst's cHild
Authors: Bemesderfer Sandra
Published: April 2008

The author's son was diagnosed with Hodgkin's lymphoma in the spring of 1997. She traces the impact of this trauma on her practice, with specific emphasis on her experience as both analyst and mother, and on the related countertransference feelings and enactments. The paper discusses in detail the analyst's effort to determine for each patient whether or not to disclose the fact of her son's illness, the internal conflict she experienced over those decisions, and the effects of her decisions on her patients. An extensive case discussion focuses on a patient who appeared to intuit in a dramatic fashion the traumatic events in the analyst's private life.
Attachment and Borderline Personality Disorder
Authors: Fonagy Peter
Published: April 2008

The author outlines his concept of reflective function or mentalization, which is defined as the capacity to think about mental states in oneself and in others. He presents evidence to suggest that the capacity for reflective awareness in a child's caregiver increases the likelihood of the child's secure attachment, which in turn facilitates the development of mentalization in the child. He proposes that a secure attachment relationship offers the child a chance to explore the mind of the caregiver, and in this way to learn about minds; he formulates this model of the birth of the psychological self as a variation on the Cartesian cogito: `My caregiver thinks of me as thinking and therefore I exist as a thinker.` This model is then applied to provide insight into some personality-disordered individuals who were victims of childhood abuse. The author proposes (1) that individuals who experience early trauma may defensively inhibit their capacity to mentalize to avoid having to think about their caregiver's wish to harm them; and (2) that some characteristics of severe borderline personality disorder may be rooted in developmental pathology associated with this inhibition. He offers evidence for and some qualifications of this model, and argues that the therapeutic effect of psychoanalysis depends on its capacity to activate patients' ability to evolve an awareness of mental states and thus find meaning in their own and other people's behavior.
A Psychoanalytic Perspective On Attention-Deficit/Hyperactivity Disorder
Authors: Gilmore Karen
Published: April 2008

Psychoanalysts have tended to view the diagnosis of AD/HD either with skepticism or as a contraindication to analytic treatment. The author reviews the history of this puzzling diagnostic entity, which is estimated to account for up to fifty percent of child referrals, and suggests that a psychoanalytic perspective on the underlying disturbance in ego functioning helps to clarify the nature of the symptom picture. Whatever the etiology, which may be compound, she suggests that psychoanalytic treatment, most often in conjunction with psychopharmacological therapy, can address the core disturbance in ego integration that creates the familiar triad of inattention, impulsivity, and hyperactivity.
On the Vicissitudes of Early Primary Surrogate Mothering II: Loss of the Surrogate Mother and Arrest of Mourning
Authors: Hardin Harry T. , Hardin Daniel H.
Published: April 2008

Among the catastrophic events experienced by infants and young children, one of the most frequent is the loss of an early primary surrogate mother (EPSM). Usually permanent, the loss is often followed by the advent of a new, “replacement” caregiver. One aspect of the emotional environment is unique to this kind of caregiving situation: that parents are often unable to validate the true nature of their child's relationship with the EPSM or, ultimately, the trauma experienced by the child when the EPSM leaves. The marked discrepancy between the parent's and the infant or child's experience of the surrogate mothering leads to an arrest of the child's mourning process, with the potential for serious developmental consequences. Issues related to EPSM loss and its aftermath are examined in the light of two examples. Further exploration of the environment of this kind of caregiving directs attention to the critical need to nurture and protect the attachments of both the infant or child and the parent to the ESPM.
Disorganized Infant, Child, and Adult Attachment: Collapse in Behavioral and Attentional Strategies
Authors: Hesse Erik , Main Mary
Published: April 2008

This presentation focuses on the disorganized/disoriented (Group D) categories of infant, child, and adult attachment. The infant D category is assigned on the basis of interruptions and anomalies in organization and orientation observed during Ainsworth's strange situation procedure. In neurologically normal low-risk samples, D attachment is not substantially related to descriptions of infant temperament, and usually appears with respect to only one parent. At six, former D infants are often found to be role-inverting (D-Controlling) towards the parent, while drawings and separation-related narratives (D-Fearful) suggest continuing states of fear and disorganization. In adults, marked lapses in reasoning and discourse surrounding the discussion of loss or abuse during the Adult Attachment Interview (AAI) causes a transcript to be assigned to Unresolved/disorganized (U/d) adult attachment status, which predicts infant D attachment. Bowlby's theory is extended, with the proposal that certain forms of frightening parental behavior will arouse contradictory biologically channeled propensities to approach and to take flight from the parent. Maltreated infants are therefore highly likely to be disorganized. Also identified are subtler forms of frightening parental behavior (including dissociative behavior and anomalous forms of frightened behavior) that appear to lead to infant disorganization. This suggests that infant D attachment may at times represent a second-generation effect of the parent's own continuing unresolved responses to trauma. Infant D attachment predicts disruptive/aggressive and dissociative disorders in childhood and adolescence, while U/d adult attachment appears frequently in psychiatric and criminal populations. Clinical implications are discussed.
Primary Femininity: Clinical Advances and Theoretical Ambiguities
Authors: Kulish Nancy
Published: April 2008

This paper examines the use of the term “primary femininity” in current psychoanalytic thinking. The concept of primary femininity arose in reaction to early theories about female sexuality and development; based on a model of male development, these presented problems when applied to females. The author attempts to demonstrate the clinical advances that have resulted from the idea of primary femininity. At the same time she argues that the idea has been used to carry widely differing meanings, and has reflected many writers' differing frames of reference, which range from gender identity through biological traits, object relations, genital anxieties, and bisexuality. Like the terms it originally was intended to replace or augment, it has come to be used reductionistically or loosely. The author warns against its misuse and argues that primary femininity is not a unitary concept, but rather encompasses a related group of ideas about the female body and mind.
Body Ego and the Preoedipal Roots of Feminine Gender Identity
Authors: Lasky Richard
Published: April 2008

Traditionally, visual cues (that is, seeing the difference between one's own genitals and those of the opposite sex) and the fantasies that they prompt were thought to be the central determinants in the organization of gender identity. More recently attention has been focused on mother-infant interaction patterns, on the construction of the body itself, on its kinesthetic sensations, and on the fantasies that these evoke. These matters are now thought to be equal in importance to the traditional considerations. The resulting concept of a core gender identity has suggested the possibility of various forms of preoedipal genital anxiety. This paper discusses how two experiences common to childhood as well as adulthood—the tumescence of erectile tissue and the involuntary vaginal secretions of sexual arousal—may contribute to the organization of feminine gender identity. Case material, including a close examination of an analytic hour, is presented to show how this process may manifest itself in adult neurotic conflict.
The Organized Categories of Infant, Child, and Adult Attachment: Flexible Vs. Inflexible Attention Under Attachment-Related Stress
Authors: Main Mary
Published: April 2008

From an evolutionary perspective, a central mechanism promoting infant survival is the maintenance of proximity to attachment figures. Consequently attachment figure(s) represent the infant's primary solution to experiences of fear. Aspects of the development of the field of attachment are outlined within this context, beginning with Bowlby's ethological/evolutionary theory, and proceeding to Ainsworth's early descriptions of infant-mother interaction in Uganda and Baltimore. Using a laboratory procedure called the strange situation, Ainsworth identified three organized patterns of infant response to separation from and reunion with the parent. Narratives derived from videotaped strange situation behavior of infants in each category (secure, avoidant, and resistant/ambivalent) are provided, together with a discussion of the prototypical sequelae of each category (e.g., school behavior, and separation-related narratives and drawings at age six). The Adult Attachment Interview (AAI) and the move to the level of representation are also described. AAI transcripts are presently analyzed according to the speaker's capacity to adhere to Grice's maxims of rational cooperative discourse, and three organizedAAI categories, or states of mind with respect to attachment, have been identified ( secure-autonomous, dismissing, and preoccupied). When the interview is administered to parents who have been seen with their infants in the strange situation, each AAI category has repeatedly been found to predict that infant's strange situation response to that parent. Illustrations of the discourse characteristic of each category are provided, and it is noted that individuals with apparently unfavorable life histories are found to have secure offspring, providing that their history is recounted coherently. Like infant strange situation behavior, differences in adult security as identified through discourse patterning are interpreted in terms of attentional flexibility or inflexibility under attachment-related stress.
The Development and Organization of Attachment: Implications for Psychoanalysis
Authors: Slade Arietta
Published: April 2008

As a result of John Bowlby's breach with the British Psychoanalytic Society nearly forty years ago, his work, specifically the development of attachment theory, was until recently largely expunged from the psychoanalytic record. However, thanks to developments in both psychoanalytic and attachment theories, a rapprochement has been forged, and a number of scholars are now seeking to integrate these two complementary perspectives. In this paper, the fundamental premises of attachment theory are discussed in light of their relation to psychoanalytic theory. In addition, their application to the clinical situation in both adult and child treatment is discussed.
The Older Patient in Psychoanalysis
Authors: Valenstein Arthur F.
Published: April 2008

The demographic shift toward extended longevity has led to a commensurate increase in the length of the working and productive years, and with it an increase in the number of so-called “older” patients who come into psychoanalysis or psychoanalytic psychotherapy. This led the Psychoanalytic Research and Development Fund to support a four-year study by a small group of experienced psychoanalysts of “the older patient in psychoanalysis.” Aging and old age are considered to be the final developmental crisis of the successive epigenetic phases of the life cycle. Eleven case presentations and various briefer clinical vignettes informed us that older and even old individuals, who seek treatment themselves or who are appropriately referred, respond in a positive and effective fashion to psychoanalysis and psychoanalytic psychotherapy. As do younger patients in analysis, such older people, motivated by the wish to make the most of what time is left, become interested in understanding their pasts with respect to the present and the future. The life stories of two older men who undertook analysis, and the courses and outcomes of their analyses, illustrate our findings and impressions. In both cases conflicts and difficulties from earlier developmental phases, extending back even as far as the oedipal and preoedipal years, were revived during their older years. And although these conflicts might have been beyond definitive resolution, what is salient is the extent to which they were ameliorated: sufficiently that they did not impede a satisfactory adaptive solution of the final crisis of the normative sequences of the life cycle.
An Empirical Study of Seriously Disturbed Suicidal Patients
Authors: Fowler J. Christopher , Hilsenroth Mark J. , Piers Craig
Published: April 2008

Aspects of unconscious processes in a group of seriously disturbed psychiatric patients are examined in an effort to predict near-lethal suicide attempts and explore psychoanalytic formulations of suicide. The Rorschach Inkblot Test, the most widely used projective measure in suicide research (Bongar 1991), was chosen for its potential to shed light on specific unconscious processes. Psychic states commonly associated with suicide were measured by psychoanalytic Rorschach analog scales and then subjected to a progression of statistical analyses in order to predict future occurrence and lethality of suicide attempts. On the basis of a priori hypotheses, the authors developed a suicide index comprising four psychoanalytic Rorschach signs that predicted, with considerable accuracy, which patients would later make near-lethal suicide attempts. The best predictors were unconscious processes indicative of penetrating affective overstimulation, disturbance in the capacity to maintain adequate ego boundaries, and depressive affective states characterized by a morbid preoccupation with death and inner decay. These findings provide empirical support for several well-known formulations of the unconscious motivations for suicide.
Psychoanalysis and Schizophrenia: a Cautionary Tale
Authors: Willick Martin S.
Published: April 2008

The history of psychoanalysis and schizophrenia is used as an example of psychoanalytic theories of etiology that have not stood the test of time. Those theories pointed to three main factors: very serious inadequacies in the caretaking person; the presence of these inadequacies so early, during the preverbal period, that they led to the impairment of early object relations, the development of psychic structure, and basic ego functions; and the absence of underlying biological abnormalities. Today, many analysts are still reluctant to acknowledge biological etiological factors for other psychiatric conditions. For illnesses such as borderline conditions and various severe character disorders for which biological factors are still much in doubt, analysts are today proposing etiological formulations similar to those once advanced for schizophrenia. These formulations may indeed prove correct for these disturbances, but analysts are urged to heed the cautionary tale of psychoanalysis and schizophrenia.
Life-Threatening Illness in the Analyst
Authors: Fajardo Barbara
Published: April 2008

The literature on practicing throughout a life-threatening illness is reviewed and important differences about attitudes toward self-disclosure are understood by noting a division between two perspectives on transference: “one-body” and “two-body” views. The analyst's use of self-disclosure is informed by the prominence given the interpretation of transference as against that given the patient's needs in the collaborative relatedness supporting the therapeutic alliance. Themes and illustrative clinical vignettes are presented from the author's own experience practicing during such an illness. Three phases of working during illness are delineated, each somewhat different regarding the analyst's state, and hence patients' needs and reactions. Recommendations are made regarding conditions that make it possible to work effectively during a life-threatening illness. The analyst needs help from his or her own analyst to make the clinically and sometimes ethically appropriate decisions about practice; while this is important in instances in which the analyst recovers, it is essential should the analyst become terminal and face more certain death.
Speaking the Unspeakable: Institutional Reactions To Boundary Violations By Training Analysts
Authors: Peltz Morris L. , Gabbard Glen O. ,   COPE Group on Boundary Violations
Published: April 2008

The work of a COPE study group on boundary violations is summarized, with particular focus on the impact on institutes and societies of sexual misconduct by training analysts. Difficulties in evaluating such situations are discussed, and the dynamics of institutional avoidance explicated. In addition, psychodynamic themes that are commonly observed in analysts who engage in sexual boundary violations with their patients are elaborated. Finally, suggestions are made for managing, through existing mechanisms, instances of boundary violations by training analysts.
The Effects of the Introduction of Medication On the Psychoanalytic Process: a Case Study
Authors: Greene Marshall A.
Published: April 2008

The past fifteen years have seen a marked change in the attitude of psychoanalysts toward the use of medication in psychoanalysis, yet few detailed case studies have appeared in which the effects of the introduction of a medication on the psychoanalytic process have been studied. A plea for fluoxetine (Prozac) as a weight-loss aid, from a female patient whose analysis had progressed satisfactorily, set in motion a remarkable series of events. Her mood brightened, she rapidly lost weight, and she ultimately realized that she had the fantasy of being impregnated, all of which represented the reenactment of crucial childhood experiences. The most significant change in the psychoanalytic process was a newfound ability to experience critical thoughts and feelings, which previously had been prohibited by her harsh superego. At first both patient and analyst believed that the medication had “softened” her superego, but reexamination of the data revealed that most, if not all, of the changes could be attributed to the transference meaning of the collaboration rather than to the effects of the drug.
On “Telepathic Dreams?”: an Unpublished Paper By Robert J. Stoller
Authors: Mayer Elizabeth Lloyd
Published: April 2008

In 1973 Robert Stoller wrote a paper on a series of dreams—his own and his patients'—that he reluctantly found himself calling `telepathic.` He never submitted the paper for publication, though he returned to the topic of unconscious communication and telepathy with increasing fascination in the years before his death. Publication of Stoller's paper seems particularly opportune just now. In it he pleads for open-minded examination of data, however alien to current scientific belief those data seem. In the past, despite numerous published reports of possibly telepathic experiences in analysis, their investigation remained relatively one-sided, since a technical posture of anonymity with patients constrained analysts from revealing that a communication struck them as telepathic. This has limited what analysts have been able to learn about the information actually exchanged, how it was exchanged, and whether the communication was experienced as uncanny by the patient. Recent attention to the intersubjective nature of the analytic situation has led to a deemphasis of anonymity, opening freer dialogue that may facilitate the rigorous investigation Stoller calls for. Such investigation may further analytic understanding of unconscious mental function and communication in the clinical setting, and lend perspective to the growing body of carefully controlled experimental research on anomalous mental phenomena.
Metaphors of a Bodily Mind
Authors: Rizzuto Ana-Maria
Published: April 2008

Patients' metaphors in analysis may allow access to ineffable experiences. This is understandable, since the mind is a bodily mind, and language is a fully embodied function of this mind.That is, both are dependent for their existence upon the physical body. The ontogenic accumulation of perceived sensory impressions and affective processes far exceeds what can be put into words. Research in cognitive psychology suggests that the active mind functions in such a manner that later perceptions are organized by means of earlier ones. However, since the mind can know only its own representations, it inhabits two ever unknown realms: the external world itself, and the domain of internal unconscious processes that sustain the mind's functions. As a result, the world and the self we know are constructed by the mediation of our bodies. In language also, the active mode by which we perceive, process, and feel makes our understanding of words dependent on previous experience. The fact that the limbic system is activated immediately in the moment of processing experience means that all modalities of representation include an affective valuation.This inevitable processing of information through the mediation of affectively valued bodily perceptions gives the metaphorical function—the human capacity to organize experience and life in metaphoric ways—the ability to create linguistic metaphors that can capture and express otherwise inexpressible psychic experiences. This manner of understanding metaphor has implications for psychoanalytic technique.
The Interpersonal and Freudian Traditions: Convergences and Divergences
Authors: White Robert S.
Published: April 2008

The traditional Freudian and interpersonal schools of psychoanalysis diverged during the psychoanalytic wars in New York in the 1940s. Each has developed from a different set of assumptions concerning the mind, especially the role of structure and the role of interaction. Recent developments in both schools in the last twenty years suggest a convergence and overlap in theory and technique. The relevant history of the divergence is examined and the work of three contemporary interpersonal writers explored in depth. That work is contrasted with contemporary developments in traditional Freudian psychoanalysis.
How Treating Psychoanalysts Respond To Psychotherapy Research Constraints
Authors: Busch Fredric N. , Milrod Barbara L. , Rudden Marie , Shapiro Theodore , Roiphe Jean , Singer Meriamne , Aronson Andrew
Published: April 2008

The psychoanalytic community increasingly recognizes the importance of research on psychoanalytic treatments, yet a significant number of psychoanalysts continue to believe that research is either irrelevant to psychoanalysis or impossible to accomplish. Psychoanalysts who accept the value of research express concern that intrusions required by research protocols create significant distortions in the psychoanalytic process. The authors, all psychoanalysts, are studying the outcome of a brief (twenty-four-session) psychodynamic treatment of panic disorder. They report their experiences and struggles with the intrusions of videotaping, working with a treatment manual, and time-limited treatment. This research process required them to question old beliefs and to confront feelings of disloyalty toward their analytic training and identity, particularly with regard to keeping a “clean field” and routinely performing long-term analysis of character. The therapists' psychoanalytic knowledge, however, emerged as crucial for them in managing specific research constraints. Despite concerns about providing inadequate treatment, therapists were found to engage patients with psychoanalytic tools and focus in vibrant and productive therapies that led to significant improvements in panic symptoms and associated quality of life. The authors suggest that psychoanalysts have been overestimating the potential damage of research constraints on psychoanalytic process and outcome.
Brief Communication: a Comparison of the Place of Dreams in Institute Curricula Between 1980—1981 and 1998—1999
Authors: Kantrowitz Judy L.
Published: April 2008

The analysis of dreams was central in demonstrating Freud's theory of mind and the power of unconscious forces. Many analysts informally comment that dreams no longer seem to hold the same centrality they had for analysts who were trained prior to the 1980s. This paper presents a brief study assessing whether there has been a change in the teaching of dreams in psychoanalytic institutes. Comparison of theoretical and clinical courses on dreams in 1980—1981 and 1998—1999 indicates that the actual number of hours devoted to teaching dreams has in fact decreased. However, there are indications that a renewal of interest in dreams may now be occurring, at least in some institutes. The relationship between views on the role of dreams and perspectives on psychoanalysis itself is discussed.
Psychic Reality in the Psychoanalytic Process
Authors: Meissner W.W.
Published: April 2008

The case is made for regarding psychic reality as synonymous with subjective (conscious) experience, which is inherently open to, but not reducible to, unconscious determinants. Both analyst and analysand engage in the analytic relation and interaction from the perspective of their respective psychic realities.Thus, components of the analytic relation—transference/countertransference, alliance, and real relation— are forms of psychic reality. The tensions of subjectivity and objectivity are discussed in relation to the analytic situation, especially with regard to whether the patient's or the analyst's psychic reality is to be given priority or preference. The same reality, situation, or relationship can be viewed from different perspectives and subjected to varying interpretations without any one being exclusively true or false—each may be partially true and/or partially false. The patient's recounting of his history is a part of the patient's psychic reality that intersects with a necessarily divergent account constructed by the analyst. The ensuing dialogue seeks a form of real coherence that is mutually realistic and makes realistic sense for both parties. Reliance on subjective psychic reality becomes a possible, but precarious and potentially misleading, basis for analytic understanding without other observational (verbal and behavioral) or objective data.
Integrating Male and Female Elements in a Woman's gEnder Identity
Authors: Balsam Rosemary
Published: April 2008

Despite advances in female developmental theory since the 1970s, there remains a lingering tendency to stereotype and polarize gender identity. The key to this puzzle may be found in the legacy of early libido theory, which offers an unintegratable solution for women. This is because in order for a woman to claim femininity according to this early theory, her masculine trends in development must be repudiated and `overcome.` A contemporary theory based on primary femininity suggests that this early theoretical `either/or` dilemma puts forward a developmentally immature solution. The analysis of a thirty-year-old woman, and a commentary contrasting `old` and `newer` ways of thinking on the part of the analyst, demonstrate that an interweaving pattern of paternal identifications and male body representations, together with the female body image and female identifications, is necessary to create a mature gender identity portrait. The female body representation and maternal identifications may indeed be enhanced by male internalizations, as happened in this particular instance.
Oedipus or Orestes? Homosexual Men, Their Mothers, and Other Women Revisited
Authors: Goldsmith Scott J.
Published: April 2008

The psychodynamic relationship between homosexual sons, their mothers, and other women in their lives is reexamined. The limitations of earlier writings on the topic are discussed, and a reconceptualized psychoanalytic model is presented for understanding some aspects of the relationships between these sons and their mothers during childhood. In particular, the oedipal stage of development is reformulated to coincide with the sexual orientation of the developing boy. This stage is then examined in the context of the discordant psychosocial environment in which it is often played out. The usefulness of this construct for understanding aspects of the psychosocial development of gay men throughout their lives, particularly their relationships with women, is explored through the examination of clinical data from a number of sources. Finally, the implications of this model for psychotherapeutic endeavors with homosexual men are considered.
Freud's Struggle With Misogyny: Homosexuality and Guilt in the Dream of Irma's Injection
Authors: Lotto David
Published: April 2008

The highly condensed dream element trimethylamin is central to the dream of Irma's injection. After a brief review of the medical literature on timethylamine (TMA), it is suggested that two important meanings of this chemical and its properties lie in its disguised reference to disparaging views of women, as well as to Freud's homosexual connection to Wilhelm Fliess. Freud's misogynistic and homosexual impulses were stimulated by Fliess's recent surgical error committed while operating on Freud's patient Emma Eckstein. Evidence is presented that the collaboration between Freud and Fliess in performing an aggressive act toward a woman was for Freud an enactment of a childhood situation in which he and his nephew John had ganged up on John's sister Pauline. The later relationship between Freud, Jung, and Sabina Spielrein is seen as an additional reenactment of this childhood triangle. An examination of Freud's associations to and analysis of the Irma dream, as well as some of his later relationships with women, indicates that guilt and the wish to make reparation were also prominent themes in Freud's inner life.
Knowledge and Authority: the Godfather Fantasy
Authors: Person Ethel Spector
Published: April 2008

Three strategies are tentatively proposed by which human beings try to assuage the need for transcendence: (1) seizing the godhead; (2) submission to God; and (3) the godfather fantasy, whereby an attempt is made to clothe a mere mortal in the cloak of godly power. These strategies are connected to our innate, often conflicted, tendencies to obedience and rebellion, later elaborated into submission to authority or resistance to or cooptation of authority. These psychic tendencies are illustrated in Dostoevsky's “The Legend of the Grand Inquisitor” and in Mario Puzo's The Godfather, both brilliant demonstrations of social hierarchical control. The almost universal pull to obedience is demonstrated in the research of Stanley Milgram on obedience in hierarchical situations and theorized by Freud in his formulation of “the thirst for obedience” as a product of infantile life. It is proposed that the function of the group mind, in the form of ideology, is to counter anxieties generated throughout life, not only the remnants of childhood anxiety but also fears of death and oblivion. That a person's will to power can get out of hand and lead to disaster hardly needs saying; yet the will to submission, when connected to a shared ideology, can lead to results no less devastating. More people are killed in the name of an ideological cause run amok than are destroyed by virtue of thwarted passion, personal vendettas, criminality, or greed.
The Overstimulation of Everyday Life: I. New Aspects of Male Homosexuality
Authors: Phillips Sidney H.
Published: April 2008

Western heterosexual culture surrounds the homosexually inclined boy in a climate of erotic overstimulation that powerfully affects his development and adult sexual adaptation. This assertion is illustrated through a case presentation of a homosexual man who shared a bed with his brother from childhood into adolescence. Analysis of the patient's transference enactment—repeatedly falling asleep on the couch—gradually revealed the psychic impact of this everyday overstimulation: the creation of a tantalized inner world of longing. The regular occurrence and developmental understanding of adolescent homosexual boys' unrequited love affairs with adolescent heterosexual boys are described and explored. Finally, the overstimulation of everyday life is proposed as a new model for understanding certain behavioral aspects of male homosexuality, such as the avoidance of rough-and-tumble play in childhood and homosexual cruising.
Words and Wordlessness in the Psychoanalytic Situation
Authors: Stern Donnel B.
Published: April 2008

The difference between words and wordlessness in the psychoanalytic situation is examined in the context of a detailed clinical example. Various pairs of terms that have been used to account for this difference are mapped onto it: word and act, thought and feeling, public and private experience. Each of these sets of differences suggests certain relations between consciousness and the unconscious, and each implies a position about the nature of language. All three prove to be incomplete or inadequate ways of accounting for the difference between words and wordlessness in the clinical setting. The divergence, though, is well described by the difference between self-reflection and unformulated experience. Reflection is then presented as situated in the unformulated background meanings that contextualize it. It is because of this contextual embeddedness that self-reflection can have the kind of depth, resonance, power, and nuance more commonly associated with the nonverbal. In the creation of an explicit meaning, we simultaneously reconfigure the wordless background, thereby creating new possibilities for other meanings.
Developments in Cognitive Neuroscience
Authors: Westen Drew , Gabbard Glen O.
Published: April 2008

An integration of psychoanalytic theory with contemporary developments in cognitive neuroscience offers a useful perspective on long-standing controversies about the nature of transference, and a better understanding of the precise mechanisms by which transferential processes occur. Contemporary psychoanalytic views of transference are reviewed, and the many processes that constitute transference are described. Two issues that have emerged in different guises for several decades—the role of the analyst in eliciting transference, and the nature of “real” and “transferential” components of the therapeutic relationship—are reconsidered in the light of concepts such as connectionist networks. Although a useful analytic stance is one that allows the patient's enduring dynamics to dominate the analytic field, it is suggested, anonymity is neither a cognitive possibility nor the driving force behind most transference reactions, and the distinction between “real” and “transferential” perceptions is one of therapeutic interest, not of mechanism. Certain features of the analytic situation make some dynamics more likely than others to enter the treatment relationship, notably those related to authority, intimacy and attachment, and sexuality. Transference reactions are best understood as constructed from a combination of the patient's enduring dispositions to react in particular ways under particular conditions; features of the analytic situation and of the analyst; and interactions between patient and analyst. These reactions do not unfold ineluctably from the patient's mind in the consulting room, nor are they cognitive constructions of the patient-analyst dyad or co-constructions of relatively equal partners exerting their influence on the analytic field.
Mourning Analysis: The Post-Termination Phase
Authors: Craige Heather
Published: April 2008

One hundred twenty-one analytic candidates who had completed training analysis responded to a survey about their post-termination experience. Seventy-six percent of respondents experienced a mourning process that lasted on average between six months and a year, while 24 per cent experienced no discernible sense of painful loss. Twenty candidates were interviewed to obtain a deeper understanding of the mourning process that follows analysis. During the post-termination phase, the analysand's self-analytic capacity is tested in the struggle to contain and understand feelings about the loss of the analyst, as well as transference reactions triggered by that loss. After a “goodenough analysis,” the analysand internalizes not only the analyst's functions and attitudes toward him or her, but also a sustaining, positive internal image of the analyst. Four cases illustrate unexpected difficulties that may emerge during the post-termination phase when the loss of the analyst is experienced as a repetition of earlier, traumatic losses or as a rupture of an unanalyzed, selfobject transference.
Psychoanalytic Patients in the U.S., Canada, and Australia: II. A DSM-III-R Validation Study
Authors: Doidge Norman , Simon Barry , Lancee William J. , First Michael , Brunshaw Jacqueline , Brauer Lee , Grant Donald C. , Stevens Annette , Oldham John M. , Mosher Paul
Published: April 2008

A study was conducted to validate our previous work on the DSM-III-R disorders diagnosed in patients in psychoanalysis in the U.S., Canada, and Australia and to determine which specific mood, anxiety, and personality disorders were the most common in these patients. The earlier study consisted of three surveys of psychoanalytic practice that together obtained data on 1,718 patients, through extensive mail surveys to analysts in the three countries. In the validation study, 206 patients were diagnosed using a different technique. Analysts similar in important respects to those who participated in the original surveys rated patients diagnostically before and after DSM-III-R training. After training, no significant changes appeared in the rates for any of the specific mood disorders. For the thirty disorders examined, training effects decreased the identification of the generalized anxiety disorder, and increased the identification of three personality disorders: avoidant, dependent, and personality disorder not otherwise specified. Thus, analysts slightly underdiagnosed the number of personality disorders, and some “anxious” patients appear to have qualified for personality disorders. Some limitations of the DSM-III-R notion of narcissistic personality are discussed, as are the importance and stability of the self-defeating (masochistic) personality disorder. The most common Axis I disorder in psychoanalytic patients was dysthymia, followed by major depression, recurrent. This study reinforces the findings of the original three surveys. Minor corrections were developed to adjust the original three surveys.
Quantitative Research On the Primary Process: Method and Findings
Authors: Holt Robert R.
Published: April 2008

Freud always defined the primary process metapsychologically, but he described the ways it shows up in dreams, parapraxes, jokes, and symptoms with enough observational detail to make it possible to create an objective, reliable scoring system to measure its manifestations in Rorschach responses, dreams, TAT stories, free associations, and other verbal texts. That system can identify signs of the thinker's efforts, adaptive or maladaptive, to control or defend against the emergence of primary process. A prerequisite and a consequence of the research that used this system was clarification and elaboration of the psychoanalytic theory of thinking. Results of empirical tests of several propositions derived from psychoanalytic theory are summarized. Predictions concerning the method's most useful index, of adaptive vs. maladaptive regression, have been repeatedly verified: People who score high on this index (who are able to produce well-controlled “primary products” in their Rorschach responses), as compared to those who score at the maladaptive pole (producing primary-process-filled responses with poor reality testing, anxiety, and pathological defensive efforts), are better able to tolerate sensory deprivation, are more able to enter special states of consciousness comfortably (drug-induced, hypnotic, etc.), and have higher achievements in artistic creativity, while schizophrenics tend to score at the extreme of maladaptive regression. Capacity for adaptive regression also predicts success in psychotherapy, and rises with the degree of improvement after both psychotherapy and drug treatment. Some predictive failures have been theoretically interesting: Kris's hypothesis about creativity and the controlled use of primary process holds for males but usually not for females. This body of work is presented as a refutation of charges, brought by such critics as Crews, that psychoanalysis cannot become a science.
A New Language for Psychoanalytic Diagnosis
Authors: Shedler Jonathan
Published: April 2008

Many psychoanalysts believe it is impossible to conduct empirical research without eviscerating or trivializing psychoanalytic constructs, and past research efforts have all too often reinforced this view. A new method for studying personality and personality pathology is presented that challenges such beliefs. This method, the Shedler-Westen Assessment Procedure (SWAP), captures the richness and complexity of psychoanalytic constructs and formulations while also providing reliable data for research. The method is being used to develop a new personality disorder taxonomy, as an alternative to the DSM, that is both empirically grounded and psychoanalytically relevant. Its role in psychoanalytic training and supervision is discussed, as is its value as a measure of structural change in psychoanalytic process and outcome research.