bluuebunny/crossref_metadata_2025 huggingface dataset:
The American Psychoanalytic Association: a Decade of Change
Authors: Margolis Marvin
Published: April 2008

The American Psychoanalytic Association in the last decade has undergone the most extensive organizational changes in its history. Efforts at inclusion, outreach, and democratization have halted a decline in candidates, active members, and cultural influence and led to a vibrant, growing organization, as new professional groups have gradually been included in the association's training programs. The goal of increasing training opportunities for minority candidates has only partially been achieved. A recent effort to offer affiliate status to psychotherapists and students has begun, though with modest results. Alliances with other psychoanalytic groups have led to creation of the Psychoanalytic Consortium and steady progress toward external accreditation of institutes and licensure of psychoanalysts. In the interest of unification there is a need to develop pathways of affiliation and membership for independent institutes and societies that desire to join the association. Democracy has in large measure already been enhanced at the national level. Deliberations are now transparent, and an invigorated Executive Committee willingly shares power with the Executive Council. Candidates now are deeply involved in the governance of Board and Council and their committees. But only when all members and candidates enjoy full voting rights and all members are able to serve as officers and Executive Councilors will the decades-long effort to democratize the association be concluded.
The Analyst's Knowledge and Authority: a Critique of the “New View” in Psychoanalysis
Authors: Eagle Morris N. , Wolitzky David L. , Wakefield Jerome C. , Eagle Morris N. , Wolitzky David
Published: April 2008

A critical assessment is presented of positions recently taken by Mitchell and Renik, who are taken as representatives of a “new view” in psychoanalysis. One article by Mitchell and two by Renik are examined as paradigmatic of certain ways of construing the nature of mind, the analyst's knowledge and authority, and the analytic process that are unduly influenced by the postmodern turn in psychoanalysis. Although “new view” theorists have made valid criticisms of traditional psychoanalytic theory and practice, they wind up taking untenable positions. Specifically called into question are their views on the relation between language and interpretation, on the one hand, and the mental contents of the patient on the other. A disjunction is noted between their discussion of clinical material and their conceptual stance, and their idiosyncratic redefinitions of truth and objectivity are criticized. Finally, a “humble realism” is suggested as the most appropriate philosophical position for psychoanalysts to adopt.
Concurrent Therapies: a Model for Collaboration Between Psychoanalysts and Other Therapists
Authors: Graller Jack , Nielsen Arthur , Garber Benjamin , Glusberg Davison Lisette , Gable Leslie , Seidenberg Henry
Published: April 2008

Many psychoanalysts treat individuals who are simultaneously in couples therapy or whose partners are in individual therapy. If such cases stall, some analysts may seek consultation from a colleague, though most have accepted the tacit historical prohibition against communication between therapists treating members of the same family. Experience, however, suggests that a certain form of communication between such therapists can have a powerfully enhancing effect on the concurrent therapies. After a review of the literature, the advantages, disadvantages, and impediments to collaborative cross-communication are examined. A model is then presented for use in ongoing discussion between therapists, and is illustrated with two clinical examples. The proposed model centers on the transference-countertransference configurations within the therapeutic field, and serves as an organizer highlighting areas for discussion.
The Analyst's pArticipation: a New Look
Authors: Greenberg Jay
Published: April 2008

Over the past fifteen years or so, advocates of a relational theory of psychoanalytic process have developed a compelling challenge to the classical approach to clinical work. Their critique of a fixed `standard technique,` applicable across the board to all analyzable patients, has been particularly effective. The new approach opens the possibility of tailoring technique to individual analysands, negotiating the best way of working within each unique analytic dyad. But despite the openness of relational theory, many of the most influential clinical vignettes in the recent literature emphasize the analyst's risk-taking, engaging patients in a highly personal way that breaks the traditional analytic frame. Various implications of the tendency of relational analysts to emphasize this sort of intervention are discussed, and questions raised about the way this may affect how relational thinking is received.
Questioning the Psychoanalyst's Authority
Authors: Tuch Richard H.
Published: April 2008

Sources of the trend to question not just the analyst's authority to interpret, but the analyst's use of authority in general, are explored. Out of a wish to circumvent the potentially detrimental effects an analyst's interpretations can have on patients, certain psychoanalysts have modified their analytic techniques with an eye to downplaying the role of their authority. When taken to extremes, this has led analysts to act as if they have little to offer patients in the way of an alternative point of view, and to privilege patients' accounts and interpretations by treating them as if they were objectively true. It is argued that one need not go so far in order to protect patients from the analyst's less than careful use of authority. It is argued further that the judicious use of authority remains an indispensable tool in helping to ready the patient's mind for a consideration of constructs different from those on which the patient has always relied. Finally, becoming comfortable with the aggressive aspect of the use of one's authority may determine the extent to which one is willing to employ one's authority with patients.
Are We Losing Our Mind?
Authors: Busch Fred
Published: April 2008

The individual mind of the patient, and how it works, are the central topics of this plenary address. In psychoanalysis we are always dealing with a mind—a mind with its own particular structure—and this is a fact of singular importance in how we listen to, understand, and communicate with patients. Techniques geared to this view are presented. The author reflects on and challenges some contrasting current views of psychoanalysis as primarily coconstructed or as a relational matrix. Technique according to this view highlights the analyst's subjectivity and actions as central to treatment.
Hidden Shame, Working Through, and the Problem of Forgiveness in the Tempest
Authors: Lansky Melvin R.
Published: April 2008

The problem of forgiveness is considered in the light of an examination of The Tempest. The Tempest illustrates Prospero's struggles to forgive those who betrayed him. The forgiving of an intimate's betrayal is considered as an aspect of working through an antecedent state akin to holding a grudge, blaming, or resenting, or a sense of narcissistic injury due to the betrayal. Working through depends on giving up defenses of withdrawal, omnipotent control, and splitting. These defenses are, in essence, defenses against shame that is felt in fantasy to be unbearable. They are deployed through the workings of signal anxiety (signal shame). For that reason, underlying shame dynamics are central, although manifest shame is not evident in the struggle over forgiveness. Identification of the loving aspects of an object that has been controlled and possessed for a sufficient time, and then has been relinquished and mourned, makes this type of forgiveness possible.
The Disregarded Analyst and the Transgressive Process: Discontinuity, Countertransference, and the Framing of the Negative
Authors: Reed Gail S.
Published: April 2008

This paper describes the difficulty of working with patients who have adopted conflict solutions common to perversion. These analysands' rapid shifts from one discontinuous mental state to another draw the analyst into a regressive transference/countertransference engagement characterized by alternations of actualized self and object representations. The analyst's disengagement from this regressive interaction is crucial, but difficult. A detailed clinical example illustrates the process of disengagement as well as the transformation of this transference into a more traditionally consolidated one. A technical approach is suggested and questions of representation and symbolization are explored.
Hearing Voices: the Fate of the Analyst's iDentifications
Authors: Smith Henry F.
Published: April 2008

Using detailed clinical examples, the author illustrates the function of conscious and unconscious identifications with former training analysts, supervisors, teachers, and theorists in the mind of the working analyst. As compromise formations, analytic identifications are the product of loving and aggressive wishes, defenses against those wishes, and self-punitive trends that accompany the analyst in the work. The analyst's stance at any given moment has an identificatory history that may become conscious at certain times with certain patients. While the analyst's identifications modify over time, following a predictable developmental path, they are never fully given up, but consciously and unconsciously remain an active part of the analyst's inner life. During the clinical hour they are responsive to both the analyst's and the patient's conflicts, and they coexist in a dynamic reciprocal relationship with the patient's inner life.
Psychoanalysis and Homosexuality: Do We Need a New Theory?
Authors: Auchincloss Elizabeth L. , Vaughan Susan C.
Published: April 2008

No need exists, it is argued, for a new psychoanalytic theory of homosexuality. Certainly psychoanalysis should not be expected to generate such a theory using its own methodology alone. The preoccupation with producing such a theory avoids more important questions about psychoanalytic theory building raised by an examination of the long relationship between psychoanalysis and homosexuality. These questions concern the problems related to using psychoanalytic methodology (1) to construct categories (including the categories normal and abnormal), (2) to construct causal theory (the problems include the limitations of psychoanalytic developmental theory and a long-standing confusion between psychoanalytic developmental theory, psychoanalytic genetic reconstruction, and psychodynamics), and (3) to identify “bedrock.” Finally, the question is addressed of what might be needed that is new in the psychoanalytic approach to homosexuality.
Psychoanalysis and Art, Freud and Leonardo
Authors: Blum Harold P.
Published: April 2008

Freud was the first to apply psychoanalysis to art, choosing for his subject the life and work of Leonardo da Vinci. Observing Leonardo's partly fused image of the Virgin and St. Anne, he inferred that the artist had depicted his two mothers, his biological mother and his stepmother. This very early analytic discourse on parent loss and adoption changed the course of the interpretation of art. Freud explored the psychology of art, the artist, and aesthetic appreciation. Confronting the age-old enigma of the Mona Lisa, he proposed a daring solution to the riddle of the sphinxlike smile of this icon of art. His paper prefigures concepts of narcissism, homosexuality, parenting, and sublimation. Lacking modern methodology and theory, Freud's pioneering insights overshadow his naive errors. In this fledgling inquiry, based on a childhood screen memory and limited knowledge of Leonardo's artistic and scientific contributions, Freud identified with this Renaissance genius in his own self-analytic and creative endeavor.
Finding Our Way in Perplexity: The Meanings of Sex in the Analysis of a Gay Man
Authors: Galatzer-Levy Robert M.
Published: April 2008

As preconceptions about the meaning of sexual orientation are increasingly abandoned, analysts are left with the question of how these matters are to be addressed in clinical work. These problems are explored as they emerged in analytic work between a “gay” man and a “straight” analyst. Emphasis is placed on how the search for personal meaning is impacted by the intellectual and social context inhabited by analyst and patient.
Four Men in Treatment: an Evolving Perspective On Homosexuality and Bisexuality, 1965 To 2000
Authors: Roughton Ralph E.
Published: April 2008

The author surveys his work with gay and bisexual men and his evolving clinical understanding, spanning a thirty-five-year period from 1965 to 2000. Four cases are discussed briefly, one from each decade, to illustrate the changing clinical approach, and the following conclusions drawn: (1) sexual orientation and mental health should be approached as independent dimensions; (2) heterosexual orientation is not a required outcome for successful analysis; (3) an analytic process focused on uncovering a presumed “pathological etiology” inevitably distorts the process and obscures more relevant analytic needs; (4) unrecognized heterosexist assumptions and unfamiliarity with norms of gay men's lives pose special barriers to analytic work with gay men. Ongoing self-analysis and self-education are necessary to reduce interferences that keep analysts from listening to their gay patients with open and unbiased attention.
Sexuality and Textuality
Authors: Litowitz Bonnie E.
Published: April 2008

Post-Freudian theories have been criticized for abandoning what is basic to psychoanalysis: the biological body and sexuality as the source of intrapsychic motivation. Arguably, however, they are more present than ever before—for example, in explanations by theorists who propose therapeutic actions beyond interpretation, presymbolic enactments of procedural memories, or disclosures of the analyst's bodily states as an aspect of intersubjectivity. By contrast, the Freudian body was always a text whose mediated meanings require interpretation, for which Freud provided eloquent guides. It is this textuality, and not sexuality, that distinguishes a psychoanalytic approach: a psycho-logic constructed according to a grammar of desire that mediates experience and creates interpretable behavior, both in action and in speech. Theoretical changes in psychoanalysis are traced historically along the dimension of textuality, the example of perversion is invoked, and the conclusion drawn that any theoretical approach, traditional or post-Freudian, that expands an understanding of textuality contributes to the science of psychoanalysis.
The Classical/Relational Schism and Psychic Conflict
Authors: Pray Monroe
Published: April 2008

The mind's ingrained need to reduce and resolve conflicting perspectives, it is argued, is at the root of struggles among “schools” of analytic thought. Focusing attention on the conflictual process in analytic work can help both patients and analysts appreciate the fundamentally complementary nature of mind and the value of embracing distinctive points of view.
From Monologue To Dialogue: a Transition in Psychoanalytic Practice
Authors: Shapiro Theodore
Published: April 2008

During the latter part of the twentieth century, psychoanalysts of various stripes espoused the move from free association and neutrality to various forms of intersubjectivity and dialogue. This shift is studied from the vantage point of conversational rules in terms of the shift from monologue to dialogue, using the concepts of semantics, syntax, and pragmatics. Viewing the data of analysis in this manner offers a means of evaluating the contributions of both monologue and dialogue to our understanding of the conduct of an analysis and the kind of information that can be expected to emerge. Exclusive devotion to either stance, it is argued, renders less understanding than would emerge from a balanced use of both.
The Growth and Transformation of American Ego Psychology
Authors: Wallerstein Robert S.
Published: April 2008

The roots of ego psychology trace back to Sigmund Freud's The Ego and the Id (1923) and “Inhibitions, Symptoms and Anxiety” (1926), works followed by two additional fundaments, Anna Freud's The Ego and the Mechanisms of Defense (1936) and Heinz Hartmann's Ego Psychology and the Problem of Adaptation (1939). It was brought to full flowering in post—World War II America by Hartmann and his many collaborators, and for over two decades it maintained a monolithic hegemony over American psychoanalysis. Within this framework the conceptions of the psychoanalytic psychotherapies evolved as specific modifications of psychoanalytic technique directed to the clinical needs of the spectrum of patients not amenable to psychoanalysis proper. This American consensus on the ego psychology paradigm and its array of technical implementations fragmented several decades ago, with the rise in America of Kohut's self psychology, geared to the narcissistic disorders, and with the importation from Britain of neo-Kleinian and object-relational perspectives, all coinciding with the rapid growth of the varieties of relational psychoanalysis, with its shift in focus to the two-person, interactive, and co-constructed transference-countertransference matrix. Implications of this intermingled theoretical pluralism (as contrasted with the unity of the once dominant ego psychology paradigm) for the evolution of the American ego psychology are spelled out.
Developments in Cognitive Neuroscience
Authors: Westen Drew , Gabbard Glen O. , Westen Drew , Gabbard Glen O.
Published: April 2008

The strength of psychoanalysis has always been its understanding of affect and motivation. Contemporary developments in cognitive neuroscience offer possibilities of integrating sophisticated, experimentally informed models of thought and memory with an understanding of dynamically and clinically meaningful processes. Aspects of contemporary theory and research in cognitive neuroscience are integrated with psychoanalytic theory and technique, particularly theories of conflict and compromise. After a description of evolving models of the mind in cognitive neuroscience, several issues relevant to psychoanalytic theory and practice are addressed. These include the nature of representations, the interaction of cognition and affect, and the mechanisms by which the mind unconsciously forges compromise solutions that best fit multiple cognitive and affective-motivational constraints.
The Priority of Primary Process Categorizing: Experimental Evidence Supporting a Psychoanalytic Developmental Hypothesis
Authors: Brakel Linda A. W. , Shevrin Howard , Villa Karen K.
Published: April 2008

Earlier work has provided experimental evidence for the existence of the primary and secondary process mental organization posited by Freud and has demonstrated that primary process effects are the more active unconsciously (Brakel et al. 2000). Primary and secondary processes were assessed by a categorization test in which qualitatively different principles could be used. In new experiments using the same stimuli, another significant implication of Freud's model was tested: that primary process mental organization has developmental priority. In these experiments, which studied 559 participants ranging in age from 3 to 80, it was found (1) that primary process mentation predominates in preschoolers; (2) that it is not until around age 7 that primary process organization is supplanted by secondary process organization; and (3) that after age 7 the predominance of secondary process organization remains remarkably stable throughout the life span.
Defining Character Integrity
Authors: Horowitz Mardi
Published: April 2008

Previous work on the integrity of character is reviewed and a contemporary definition offered using concepts of subordinate and supraordinate schematizations of self and relationships with others. The definition is clarified by a developmental perspective on possible growth in character integrity over the life cycle. Three types are defined by patterns in sense of identity, object relations, and defensive control of emotion. Such type formulations are useful because technique can be varied according to the inferred level of character integrity.
Enactment as Understanding and as Misunderstanding
Authors: Goldberg Arnold
Published: April 2008

The author considers the concept of enactment as a ubiquitous event that is best seen as part of a sequence in the process of understanding a patient. As such, enactments are not unusual or special save as they are often subject to disavowal or to being singled out by the analyst as especially subject to scrutiny. Once recognized, enactments need to be interpreted: not so much in terms of their unconscious origins, but more with regard to the need to include them in the analytic dialogue.
The Triadic Match: the Interactive Effect of Supervisor, Candidate, and Patient
Authors: Kantrowitz Judy L.
Published: April 2008

The triadic match is the author's term for the interaction among analytic candidate, supervisor, and patient. Overlapping or diverging characteristics of candidate and supervisor may influence the candidate's learning for good or ill depending on the way patient's and candidate's character and conflicts interact. Four candidates who had found their supervisors' character and supervisory styles particularly beneficial in relation to a particular patient volunteered to describe their experiences. Candidates and supervisors were interviewed. The aim of the paper is to illuminate factors in the match that enhanced or interfered with the candidates' learning. While the paper is presented from the perspective of the candidates' experiences, the balance between challenge and comfort in learning situations is also considered.
The Problem of Self-Disclosure in Psychoanalysis
Authors: Meissner W.W.
Published: April 2008

The problem of self-disclosure is explored in relation to currently shifting paradigms of the nature of the analytic relation and analytic interaction. Relational and intersubjective perspectives emphasize the role of self-disclosure as not merely allowable, but as an essential facilitating aspect of the analytic dialogue, in keeping with the role of the analyst as a contributing partner in the process. At the opposite extreme, advocates of classical anonymity stress the importance of neutrality and abstinence. The paper seeks to chart a course between unconstrained self-disclosure and absolute anonymity, both of which foster misalliances. Self-disclosure is seen as at times contributory to the analytic process, and at times deleterious. The decision whether to self-disclose, what to disclose, and when and how, should be guided by the analyst's perspective on neutrality, conceived as a mental stance in which the analyst assesses and decides what, at any given point, seems to contribute to the analytic process and the patient's therapeutic benefit. The major risk in self-disclosure is the tendency to draw the analytic interaction into the real relation between analyst and patient, thus diminishing or distorting the therapeutic alliance, mitigating transference expression, and compromising therapeutic effectiveness.
The Interpretive Attitude
Authors: Poland Warren S.
Published: April 2008

From its start, psychoanalysis took as its primary goal the gaining of insight, and the analyst's interpretations as its primary technique for achieving that goal. Multiple factors, including the destructive impact of wild analysis and a growing appreciation of noninterpretive analytic functions, have brought those first principles into question. The author posits a conceptual division of the analyst's interpretive functions into declarative interpretations (content) and a procedural interpretive attitude (underlying process). The interpretive attitude is presented as crucial and central to psychoanalytic work, relevant and effective even when matters touching on preverbal issues are addressed.
Consummated Mother-Son Incest in Latency: a Case Report of an Adult Analysis
Authors: Rudominer Howard S.
Published: April 2008

Reported cases of mother-son incest are very rare in the psychoanalytic literature; the fact of such incest, however, may not be so rare as has generally been believed. A detailed case report of the analysis of an adult with a history of severe physical, sexual, and verbal abuse, including consummated incest with his mother during latency, is considered in the context of other reported studies. The author raises some issues of resistance and countertransference that may influence the reporting, treatment, and perhaps even recognition of cases of mother-son incest.
Guards at the Gate: Race, Resistance, and Psychic Reality
Authors: Hamer Forrest M.
Published: April 2008

Racial difference and similarity in the treatment relationship highlight the question of what is real and apparently psychological in the different racial experiences of patients and therapists. The relationship between racial material and resistance is discussed, as well as the constancy and fluidity of race as intrapsychic content and the distinction psychoanalysts draw between social and psychic reality. Race in the mind, it is argued, is determined by both internal and external factors, and both are important in the analysis of racial material in the transference.
Slow Magic: Psychoanalysis and “The Disenchantment of the World”
Authors: Whitebook Joel
Published: April 2008

Freud's work can be situated in terms of the debate between Enlightenment and anti-Enlightenment thought. The attempts of both sides to claim Freud for their position have merit, but they miss the crucial point: namely, that the tension between its Enlightenment and anti-Enlightenment tendencies is what gives Freud's thinking much of its vitality and depth. The task that faces the interpreter is therefore to elucidate that tension and assess the alignment of forces between the two strands in his thought. An examination of the concept of magic in Freud's theory provides an opportunity to pursue this interpretive task. Although the Enlightenment position he often seems to embrace advocates the complete elimination of magic, many “magical” elements remain in his theory and clinical practice. Nor should this situation be deplored, for the ambition to completely exorcise “enchantment” from human experience is one of the misguided excesses of the Enlightenment. The question of an appropriate fate for magic in psychoanalysis is discussed in relation to the vicissitudes of the transference. Finally, the science versus hermenueutics debate is examined in the light of these considerations in an attempt to specify the unique nature of the psychoanalytic experience.
The Holding Function of Theory
Authors: Almond Richard
Published: April 2008

As multiple theoretical models contend on the American analytic scene, the holding function of theory emerges as a unifying theme. In addition to supplying an intellectual superstructure for the working analyst, theory provides a psychological presence—a sense of conviction, affective stability, reassurance, and self-esteem— that makes effective analytic work possible from the analyst's side. Ideological passions and differences arise from the vital need for the holding function in an intense and inchoate engagement like psychoanalysis. To show how adherents of different models use theory in practice, three clinical cases are reviewed, one from Betty Joseph, one from Lewis Aron, and one from the author. The last example reconstructs the analyst's subjective experience of treatment both in the selected hours and in terms of the analyst's preconscious use of theory.
Being a Candidate: Its Impact On Analytic Process
Authors: Ehrlich Joshua
Published: April 2008

Despite its crucial importance to psychoanalytic training, the control analysis has received surprisingly little scrutiny by psychoanalytic writers. How the candidate's training influences analytic process— a critical feature of the control analysis—is examined. In keeping with previous contributions, it is found that the candidate's training experience does indeed influence analytic process. It is argued, however, that focusing on the influence of training itself, as some authors have done, moves discussion away from the meanings of training for each candidate and from how these meanings bear on the interplay of transference and countertransference in the control analysis. Detailed case examples illustrate how one candidate's experience of training was drawn into his control analyses in the form of enactments, supporting the conclusion that attention to the particular ways in which training influences each candidate's analytic work is critical to the candidate's psychoanalytic education.
The Fate of the Dream in Contemporary Psychoanalysis
Authors: Loden Susan
Published: April 2008

Freud's metapsychology of dream formation has implicitly been discarded, as indicated in a brief review of trends in psychoanalytic thinking about dreams, with a focus on the relationship of the dream process to ego capacities. The current bias toward exclusive emphasis on the exploration of the analytic relationship and the transference has evolved at the expense of classical, in-depth dream interpretation, and, by extension, at the expense of strengthening the patient's capacity for self-inquiry. This trend is shown to be especially evident in the treatment of borderline patients, who today are believed by many analysts to misuse the dream in the analytic situation. An extended clinical example of a borderline patient with whom an unmodified Freudian associative technique of dream interpretation is used with good outcome illustrates the author's contrary conviction. In clinical practice, we should neglect neither the uniqueness of the dream as a central intrapsychic event nor the Freudian art of total dream analysis.
The Thrall of the Negative and How to Analyze it
Authors: Coen Stanley J.
Published: April 2008

From clinical material of patient-analyst pairs caught up in negativistic transference-countertransference enmeshment, the defensive functions of negativism are explored for both patient and analyst. Fascination with and dread of the negative intersect as patients struggle to avoid terrifying aspects of self and other. The analyst works to avoid being trapped in negativism within the dyad. Containing, metabolizing, and transforming the dyad's mutual destructiveness and mutual love enable analyst and patient to feel safer with both. How to play with the negative, to engage the patient in play at the intersection of destructive negativism and dangerous love, is described.
The Place of Annihilation Anxieties in Psychoanalytic Theory
Authors: Hurvich Marvin
Published: April 2008

Survival-related clinical reports are abundantly found in the works of classical, object-relational, and self psychological writers, but are underrepresented in major theoretical formulations on anxiety. Fears of being overwhelmed, merged, penetrated, fragmented, and destroyed, as contents of unconscious and conscious fantasies, are regularly interrelated with the typical dangers. Fifteen preliminary propositions invite closer study of such apprehensions and provide definitional components. Annihilation anxieties are triggered by survival threat; are found early but can be engendered throughout the life cycle; constitute a basic danger; are residuals of psychic trauma; have specifiable sub-dimensions; may occur in presymbolic form or be associated with fantasies in conflict / compromise formation; may arise with or without anticipation; may be accompanied by controlled or uncontrolled anxiety; are motives for defense; and may be associated with particularly recalcitrant resistances. The study of annihilation anxieties in relation to the basic danger series has both theoretical and clinical advantages, especially for understanding traumatic, anxiety, phobic, psychosomatic, addictive, narcissistic, borderline, and psychotic manifestations, as well as sexual problems (including perversions), nightmares, dissociative and panic states, and especially difficult resistances.
Thanatos and Massive Psychic Trauma: the Impact of the Death Instinct on Knowing, Remembering, and Forgetting
Authors: Laub Dori , Lee Susanna
Published: April 2008

The connection between massive psychic trauma and the concept of the death instinct is explored using the basic assumptions that the death instinct is unleashed through and is in a sense characteristic of traumatic experience, and that the concept of the death instinct is indispensable to the understanding and treatment of trauma. Characteristics of traumatic experience, such as dissolution of the empathic bond, failure to assimilate experience into psychic representation and structure, a tendency to repeat traumatic experience, and a resistance to remembering and knowing, are considered as trauma-induced death instinct derivatives. An initial focus is on the individual, on how death instinct manifestations can be discerned in the survivors of trauma. Next the intergenerational force of trauma is examined; a clinical vignette illustrates how the death instinct acts on and is passed on to the children of survivors. Finally, the cultural or societal aspects of trauma are considered, with an eye to how death instinct derivatives permeate cultural responses (or failures to respond) to trauma. Because trauma causes a profound destructuring and decathexis, it is concluded that the concept of the death instinct is a clinical and theoretical necessity.
Guilt About Being Born and Debt Concerning the Gift of Life
Authors: Lotterman Andrew C.
Published: April 2008

A very powerful form of preoedipal guilt stems from a sense of having damaged the life-giving parent with one's most basic needs. A related phenomenon is the child's sense that another subjectivity has deliberately chosen to give and sustain the child's life. This experience gives rise to a compelling mixture of awe, reverence, and obligation, a sense of guilt about being born, of debt concerning the gift of life . This sense of guilt and debt are part of every child's development. Depending on how conflicts surrounding them are negotiated, the child can come to feel either an appetite for living or a crushing sense of selfishness and unworthiness. Such forms of guilt and debt may lead not only to masochism generally, but to a particularly pernicious form of negative therapeutic reaction that can sabotage psychoanalytic work. A patient may feel, for instance, that a successful psychoanalysis is a selfish indulgence and an immoral betrayal of a sacred duty to rescue his or her parents from their misery. Guilt about being born and the sense of debt concerning the gift of life are linked to various developmental, psychodynamic, interpersonal, and cultural phenomena.
Analyzing the Traumatic Impact of Childhood Visual Impairment
Authors: Hertel Richard K.
Published: April 2008

Material is presented from three analyses involving the impact on adult functioning of childhood trauma to the visual system. The clinical process by which unrecognized but ongoing traumatic reactions are identified for subsequent analysis is described. It is of particular importance, with these patients, to recognize their lifelong experience of visual confusion resulting from problems in their visual anatomy. Only then can fantasies and affects related to these physically induced states of confusion be worked through. Working through these reactions promotes the neutralization of related primitive narcissistic affects, mourning, and realistic accommodation, and leads to a more intact and integrated sense of self, and a marked increase in self-esteem. With this newly integrated sense of self, the complex interaction between physically induced confusion states and more typical developmental conflicts with objects can be worked through, resulting in more realistic and intense cathexes of the external world. The trauma suffered by these patients had been greatly compounded by its having gone unrecognized. To miss this yet again in an analysis is to repeat the past and retraumatize the patient. These findings have clear implications for patients with other biologically related symptoms (e.g., ADD, ADHD, and dyslexia).
On the Astonishing Clinical Irrelevance of Neuroscience
Authors: Pulver Sydney E.
Published: April 2008

The clinical work of psychoanalysts can be thought of in both a narrow and a broad sense. In the narrow sense, it refers to what is commonly thought of as psychoanalytic technique, the methods analysts use to understand their patients and to convey that understanding to them. In the broad sense, it refers to the entirety of their work as clinicians: the content of understanding, as well as such things as diagnosing, estimating analyzability, recommending therapy, and prescribing medication. The current enthusiastic expectation that neuroscience will have an immediate and direct impact on clinical work in the narrow sense is misguided, but neuroscientific discoveries, it is argued, will have a major impact on psychoanalytic theory in the not too distant future. The resulting changes in metapsychology will ultimately have reverberations on clinical work in the broad sense, although psychoanalytic technique, the analyst's basic approach to patients, will remain essentially the same.
Patterns of Discourse in “Good” and Troubled Hours: a Multiple Code Interpretation
Authors: Bucci Wilma
Published: April 2008

Multiple code theory is a theory of psychological organization, which is rooted in current research in the areas of cognitive psychology, emotion, and development; it accounts for adaptive functions as well as pathology. The theory incorporates Freud's seminal discovery of modes of thought outside the conscious, rational mode, but recognizes three rather than two forms: subsymbolic nonverbal, symbolic nonverbal, and symbolic verbal. Computer-assisted procedures assessing these three forms are applied to verbatim transcripts of a long-term, fully recorded psychoanalysis. The measures point to the patient's central themes, allow evaluation of the analyst's interventions as facilitating or impeding the patient's explorations, and facilitate more rigorous comparison of differing clinical views. The discourse pattern in an early session was found to anticipate that in the treatment as a whole; the pattern in a later session indicates how this treatment may have become disrupted. The measures point to affiliative themes in the patient material that were not emphasized by previous researchers studying this case.
A Different Perspective On the Therapeutic Process: the Impact of the Patient On the Analyst
Authors: Kantrowitz Judy L.
Published: April 2008

The therapeutic process is considered from the perspective of its impact on the analyst. Analysts undertake self-scrutiny, focusing on transference and countertransference reactions, in order to facilitate the treatment of their patients. However, this self-reflection also serves to continue and enhance the analyst's own personal understanding. In the course of analyzing patients, an interactional process develops in which many of the therapeutic aspects of analysis affect the analyst as well as the patient. A clinical example is offered to illustrate this process.
Toward an Epistemology of Clinical Psychoanalysis
Authors: Ahumada Jorge L.
Published: April 2008

Epistemology emerges from the study of the ways knowledge is gained in the different fields of scientific endeavor. Current polemics on the nature of psychoanalytic knowledge involve counterposed misconceptions of the nature of mind. On one side clinical psychoanalysis is under siege from philosophical “hard science” stalwarts who, upholding as the unitary model of scientific knowledge the Galilean model of science built around the “well-behaved” variables of mechanics and cosmology, argue clinical psychoanalysis does not meet empirical criteria for the validation of its claims. On the other side, its empirical character is renounced by hermeneuticists who, agreeing with “hard science” advocates on what science is, dismiss the animal nature of human beings and hold that clinical psychoanalysis is not an empirical science but a “human” interpretive one. Taking Adolf Grünbaum's critique as its referent, this paper examines how, by ignoring the differences between “exact” and observational science, the “hard science” demand for well-behaved variables misconstrues the nature of events in the realm of mind. Criteria for an epistemology fit for the facts of clinical psychoanalysis as an empirical, observational science of mind are then proposed.
The View From the Tip of the Iceberg
Authors: Josephs Lawrence
Published: April 2008

In recent years there has been a growing interest in refining the technique of ego defense analysis. All of these approaches share in common an attempt to work closely with the patient's free associations, to interpret at a level that is accessible to the patient's consciously observing ego, and to avoid bypassing the analysis of the patient's most surface-level resistances in an effort to understand unconscious conflict. These innovations reflect a commendable effort to work in a way that is rigorously empirical, that respects the patient's autonomy, and that minimizes the pressure of the analyst's transferential authority in the patient's acceptance of the analyst's interpretations. Despite the undeniable value of these technical innovations, such approaches to ego defense analysis may inadvertently result in certain overemphases in technique that may unnecessarily constrain the analytic process. They may result in a sort of obsessive tunnel vision that is overly focused on small details to the exclusion of the larger picture. An approach that counterbalances the microscopic and the macroscopic analysis of ego defense is recommended.
Reflections On Metapsychology, Theoretical Coherence, Hermeneutics, and Biology
Authors: Gedo John E.
Published: April 2008

Unable to correlate clinical findings with contemporary neurophysiology, Freud tried to anchor psychoanalysis within biology through a speculative metapsychology. Recently, epistemological objections have led to abandonment of his proposals qua scientific theory, although many still use them metaphorically. Others deny the need for any general theory of mental functions. Some theorists would espouse a hermeneutic basis for psychoanalysis, outside the boundaries of biology; they purport to confine their purview to mental contents but often use concepts based on metapsychological assumptions. Because the meanings of such contents are difficult to determine, their interpretation should be “constructed” in collaboration with analysands. By contrast, trained observers may reliably collect psychobiological data, accumulating knowledge of cognition, affectivity, communication, and the regulation of behavior—matters Freud encompassed via the economic and structural viewpoints. Hence analytic theory should be correlated with the findings of semiotics, cognitive psychology, and brain science. The hermeneutic focus on dynamics and genetics overlooks crucial data, such as the occurrence of trauma, leading to confusion about processes of pathogenesis, working through, and structural change. These and other biological phenomena (such as functional deficits and repetitive enactments) call for interventions beyond interpreting mental contents; improvement depends on learning better to process these contents. Change implies gradual establishment of alternative neural pathways; this does not automatically follow insight. Hence psychoanalysis must deal with intrapsychic phenomena beyond subjectivity. Intrapsychic conflicts represent efforts to ward off archaic mentality (primitive thought processing). Theories divorced from neurocognitive considerations encourage the theoretical fiction that analysands possess an “intact ego.”
What Is Consciousness?
Authors: Solms Mark
Published: April 2008

In the past few years scientists and scholars in a variety of disciplines have been making concerted efforts to answer an ancient question, namely, How exactly do the physical processes in the brain cause consciousness? What is distinctive about the way in which modern scientists and scholars are approaching this question is that they are treating it as a scientific problem rather than a metaphysical one. This transition reflects the air of expectation in contemporary cognitive science to the effect that an empirical solution is imminent to a philosophical problem that previously was considered insoluble. Nevertheless, a recent authoritative review of the publications of such leading contemporary workers in the field as Francis Crick, Daniel Dennett, Gerald Edelman, Roger Penrose, and Israel Rosenfield has concluded that they have all failed to provide a satisfactory answer to the question (Searle 1995a). The present paper makes a psychoanalytic contribution to this interdisciplinary effort and provides an alternative answer to the question, based on Freud's conceptualization of the problem of consciousness. The paper takes a concrete example from Searle's review, reanalyses it within Freud's metapsychological frame of reference, and shows how this frame provides a radical solution to the problem. This implication of Freud's work has not hitherto been recognized and so has not received the attention it deserves.
How To Help Patients (and Analysts) Bear the Unbearable
Authors: Coen Stanley J.
Published: April 2008

Psychoanalytic techniques are explored through which analysts can help patients tolerate, face, and attempt to resolve affects and conflicts that have seemed unbearable to the patient. The patient's feeling of “I can't” is differentiated from the feeling of “I won't.” Process material focuses on patients' shifts between seeming inability to function as analytic collaborators and more responsible ownership and exploration of conflict. Analysts' either/or attitudes toward analyzability tend to interfere with flexible shifting between times when they can interpret and prolonged periods when they cannot interpret and the patient cannot collaborate. During the latter, the analyst needs to provide some noninterpretive function, such as holding, containing, or affirming, both for the patient and for him/herself.
Dora's Hysteria and the Maturation of Sigmund Freud's Transference Theory: a New Historical Interpretation
Authors: Makari George J.
Published: April 2008

The emergence of Freud's 1905 revision and elaboration of transference theory is situated within the context of his emerging understanding of neurosogenesis. Immediately after the seduction theory lost its credibility in the fall of 1897, Freud maintained a traumatic model for hysteria and increasingly hypothesized that repressed childhood masturbation was fundamental to the creation of hysteria. Following this interest in masturbation, Freud — influenced in part by Havelock Ellis's concept of autoerotism—put forth his first post—seduction theory model of neurosogenesis in December 1899. In this model two different developmental stages of psychosexual object relatedness—the “autoerotic” and the “alloerotic”—determined and differentiated later psychoneurotic symptomatology. This etiological schema organized the next psychopathological writing Freud did, his “Fragment of an Analysis of a Case of Hysteria,” in which Ida Bauer's hysteria was seen as due to oral zone autoerotic overstimulation and, later, to her object-directed genital masturbation. Freud in a postscript reasoned that in the analytic situation the production of neurotic symptoms ceases and is replaced by the creation of transferences. Hence it is argued that Freud, following his new two-tiered understanding of neurosis, expanded his formal description of transference by creating two analogous forms of transference, the “reprint” and the “revised edition.”