Nonverbal communication in the context of dissociative processes.

Nonverbal communication, at both conscious and unconscious levels, can be portrayed as a type of "body language," a communication between the psychic bodies of patient and therapist. In this article, the author provides several examples of this communication process in the context of a psychoanalytic treatment with a patient who has a history of trauma resulting in frequent dissociative states. Motoric actions (drawing), somatosensory symptoms, and intense affect states represent the media through which she "informs" the analyst of her painful experiences. The analyst's surrender to countertransference states, such as deadness, constitutes the beginning of attunement to the patient's body communications. In one particularly unusual symptom of dissociation, the patient exhibits physical abilities that she is incapable of in more integrated states. An attempt is made to understand this event from a phenomenological and neurobiological perspective. Using an information-processing model, the author illustrates one instance of how the patient's subsymbolic information may be converted to the verbal symbolic via the analyst's use of evoked images. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The ambiguity of the psychoanalytic situation and its relation to the analyst's reverie.

This article is about ambiguity in psychoanalysis, an ambiguity that is particularly striking in the psychoanalytic relationship between patient and analyst. The analyst is a professional in his consulting room, in his chair behind the patient, but he is at the same time a figure in the patient's realization of his inner world of objects. The analyst is a transference figure, but he is also a real person with his own inner private reverie and a subjective contribution to the analytic process. For some patients, the ambiguous analyst is an enormous challenge or threat. This article describes parts of the analytic process with one such patient, a man with an early history of severe trauma who at the start of his treatment completely denied this ambiguity and felt every reminder of his analyst being anything else but professional as a threat to his sanity. The author tries to show how the improvement of the patient's tolerance for ambiguity depended on the work done in the analyst's private reverie, a quite demanding process for the analyst. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Case reports in a two-person world.

Traditional anecdotal case reports are usually written as a 1st-person narrative, a tale told from the point of view of the treating analyst. Quotations from the patient are sometimes included, but readers rarely have access to the thoughts of either analyst or patient. Perhaps it is because of these omissions that the literature of case reports and transcribed recordings has uncovered only a few examples of persuasive interventions and has not contributed much to the understanding of what exactly brings about change in the course of psychoanalytic treatment. Perhaps the meanings readers seek are not in the published narrative but in the patient's and analyst's contexts of understanding—and these are left largely unrecorded. If ways were found to capture this context, analysts might better understand the principal ingredients of significant clinical happenings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reality and danger in psychoanalytic treatment

In recent papers there has been considerable interest in the disclosure of the analyst's erotic countertransference. In our view this discussion touches a more fundamental issue: must something "real" take place between analyst and patient in order for real change to occur? And if what takes place is "real," will it not be dangerous and potentially destructive? Tracing the history of psychoanalytic understandings of what is "real" in the patient's life and what is "real" in the transference, we explore these questions in a clinical vignette and discuss the implications of this issue for our understanding of the process of psychoanalytic treatment.     

The "unobjectionable" positive countertransference

Even though Freud said that "the secret of therapy is to cure through love," the "unobjectionable" positive countertransference has remained a neglected topic in clinical and theoretical writings. This paper explores a number of personal and historical reasons to account for this avoidance. A case vignette is presented to highlight the facilitating and therapeutic role of the positive countertransference. It also demonstrates the analyst's struggles with his loving feelings and some of the reasons behind this conflict. The case is then used to explore the functions that the positive countertransference serves for the analysand, the analyst, and the analytic process. In conclusion, a number of questions are posed for an emerging model of psychoanalytic technique that would encompass the analyst's noninterpretive contributions to the process.     

What I do with what you give me: Therapeutic action as the creation of meaning.

The thesis of this article is that the essence of analytic change lies not in what the analyst offers, but in what the patient creates from the analyst's provisions, whether these offerings are interpretations, functions, or an emotional impact. This concept of analytic change implies a clinical strategy in which interpretations are viewed as necessary preparations. The analyst's role is not only to understand, but also to facilitate the patient's creative use of interpretation by opening a therapeutic space. The inclusion of the patient's creation of new meaning in the theory of therapeutic action implies a clinical strategy in which the analyst facilitates the patient's creation, In such an analytic stance, the analyst opens therapeutic space for the patient to create new possibilities. A clinical illustration demonstrates a strategy that combines discovery and the promotion of the patient's creation of new meaning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lacanian perspectives on psychoanalytic supervision.

This article presents a Lacanian perspective on supervision within the context of the history of psychoanalytic supervision. Lacan emphasizes the importance of the personal analysis and how supervision, at times, can function as a resistance against the same. Eventually, Lacan concluded that an analyst is authorized by what he called the analyst's synthome and a few other analysts. What allows an analyst to effectively operate with the transference of the analysand is that, because of his/her own analysis, he/she knows that he/she does not know and, therefore, is generally not deceived by the transference to the "subject who is supposed to know". An analysis ends by virtue of the desire of the analyst not to remain in the position of the beloved subject who is supposed to know, and by virtue of the analysand's own "unknown-knowing." The analyst is an ex-analysand that has transformed the jouissance of his/her symptom into an Other jouissance of the synthome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Love and sex in 45 minutes: Transference love as self- and mutual regulation.

Patients who express intense, erotic attraction to their analysts pose special treatment challenges that may not respond well to the analyst's interpretive efforts. A detailed case presentation is offered, describing one such patient, who demanded that her analyst convey his interest in her concretely, insisting that he offer her gifts, tell her he loved her, and even engage her sexually. It is argued that such concrete conveyances reflect, in part, the patient's attempt to self- and mutually regulate intense, affect-laden experience. The wish that the analyst demonstrate love for the patient expressed in modulated form her history of deeply painful and frustrated longings, as well as her hope for a different outcome within the treatment relationship. Finally, their spontaneous, shared playfulness evolved into a form of ongoing relatedness that provided the patient significant understanding and acceptance while providing the analyst an appropriate means of responding to the patient's erotic demands. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Countertransference as the analyst's experience of the analysand: Influence of listening perspectives.

Discusses countertransference as part of the analyst's larger experience of the patient, to capture the complexity of the analyst's involvement and correctly place it as a central guide for inquiry and interventions. The analyst's experience of the patient is shaped not only by the patient, but also by his listening perspective, models, and subjectivities. The analyst experientially can resonate with the patient's affect and experience from within the viewpoint of the patient (subject centered), or of the other person in a relationship with the patient (other centered). The analyst's listening from within and without, oscillating in a background–foreground configuration, can illuminate more fully the patient's experience of self and of self in relation to others. Case studies of 2 women and 1 man are included. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of shame on the psychoanalysis of a borderline child.

Clinical psychoanalysis has ignored shame as the source of psychopathology, despite a burgeoning literature. Here the authors present an analysis carried out with a hospitalized child diagnosed as borderline. The analyst's efforts to interpret the patient's self-concealing behaviors elicited intensified shame reactions not clearly understood at the time. Here the authors explore the evolutionary and developmental origins of shame as a primary affect modifying the interest the organism has in novel stimuli. The authors briefly explain why clinicians overlook the relationship of shame to both psychopathology and psychoanalytic technique. In this case, the illness, based largely on the child's chronic experience of humiliation, remitted in response to the supportive influence of an extraordinarily sensitive hospital setting combined with the analyst's growing willingness to accept the child's positive response to being accepted on his own grounds. These laid the foundation for a psychoanalytic process to take place. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transference: Psychic reality and material reality.

This article explores the impact of material reality in the form of the analyst's unrecognized and enacted countertransference on a patient's psychic reality (PR) as it presents in the transference. PR refers to a patient's experience in the transference and to an organization of unconscious fantasies, encoded as compromise formations, that actively structures the present and can be inferred from the data of psychoanalysis. Clinical material is presented in support of the author's belief that PR plays the central role in the construction of the transference and that material reality can influence both the nature and form of the transference through the activation or inhibition of different sets of fantasies in the analyst and the patient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Clinical values: Emotions that guide psychoanalytic treatment.

Reviews the book Clinical Values: Emotions That Guide Psychoanalytic Treatment (2004), by Sandra Buechler. Buechler, a training and supervising analyst at the William Alanson White Institute, sets out to elucidate a number of seldom spoken-about tasks of the analyst in this thoughtful and often inspiring book. Drawing on 20 years of experience as an analyst, she sheds an intimate light on the analyst's struggle against loneliness, burnout, anxiety, and outright feelings of fear and intimidation as well as on the need to remain inquisitive, interested, and purposeful. In the first chapter of her book, Buechler directly and indirectly raises some of the questions that have concerned psychoanalysis for the last 20 years. She ponders, for instance, whether there are such things as truth and reality that exist a priori and independently of what the analyst and patient "cocreate" in the consulting room. Is the analyst's knowledge an illusion that is detrimental to the goal of fostering curiosity in treatment? What is the role of theory in treatment? Buechler manages to pose these controversial questions in such a way that one can easily lose sight of what is indeed so controversial about them. This is mainly because these issues are discussed as subheadings to her stated central focus--a set of clinical values that guide or ought to guide the analyst's work. However, Buechler's recommendations for addressing these inherent challenges become a polemical and, to my mind, an equally, if not more, interesting subject of discussion. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The emotionally engaged analyst I: Theories of affect and their influence on therapeutic action.

The salience of the analyst's emotional engagement of the patient in fostering therapeutic change is reviewed and related to the theory of emotion implicitly or explicitly held by the analyst. The analyst's conceptualization of the analytic process, attribution of meaning to the analytic dialogue, selection of interventions, and recognition of the emotional component of treatment are explored as a function of the analyst's theory of emotion. A dynamic systems theory of emotion is proffered to illuminate the complex interactions that create the emotional experience of the patient and of the analyst and that affect the nature and quality of therapeutic process itself that have not been accounted for by the commonly held theories of emotion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychoanalysis beyond Freud

Since Sigmund Freud (1856-1939) formulated his first psychoanalytic theories about 100 years ago, there has been a rapid development in psychoanalytic theory and therapy. In this paper, central concepts in the four psychoanalytic "psychologies"--drive/ego psychology, object relations theory, self psychology and interpersonal psychoanalysis--are presented. Basic concepts in psychoanalysis have been under a continuous critical review, and psychoanalytic theories remain versatile. The unconscious and the exploration of subjective experience are central common themes. The role of the psychoanalyst has changed from expert to explorer, working together with the patient. At the same time, the analyst has become more active in the therapy room. The analyst's contribution to what is happening between the analyst and the patient has been increasingly emphasized. The development in psychoanalysis has parallelled both developments in the theory of knowledge as well as the change in cultural trends. Creating meaning is central to the psychoanalytic process, but there are divergent views as to how this happens: by articulating meaning, by uncovering meaning, by constructing or deconstructing meaning. The narrative tradition in which the central point is to tell stories about oneself, is discussed more thoroughly in the paper. The authors challenge the view that psychoanalysis is the work of Freud only.     

Dynamic Systems and the Therapeutic Action of the Analyst: II. Clinical Application and Illustrations.

The author presents a dynamic systems approach to psychoanalytic practice. It depicts psychoanalysis as an activity-dependent, experientially based treatment in which the analyst's behavior toward a patient effects change in how the patient organizes and interprets self-experience and relates to others. The neurobiological and relational components of this approach are reviewed, and their implications for psychoanalytic process and technique are described. Several clinical vignettes illustrate the technical application, dynamic process, and therapeutic action of a dynamic systems perspective on psychoanalytic treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical notes on disrupted frames and violated boundaries.

Despite the fact that the analyst's work unfolds at the crossroad of a prevalent moral code, psychoanalysis has neglected to address ethical or philosophical arguments. Such arguments have significant technical implications for the discipline in regard to "dos" and "don'ts." Different approaches to moral dilemmas are considered in relation to pertinent aspects of the psychoanalytic frame and the psychoanalytic process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychoanalytic boundaries and transitional space.

The blurring of the distinction between language and action in contemporary psychoanalytic theories expands the traditional boundaries of psychoanalytic therapy. The current article delineates a conceptualization of psychoanalytic boundaries based on D. Winnicott's (1971) concept that transitional space defines the psychoanalytic process. It is proposed that D. Winnicott's (1971) concept shifts the psychoanalytic paradigm to adaptation, rather than interpretation, as the overriding analytic task. The analyst's adaptation and its limitations define the psychoanalytic dyad, and psychoanalytic boundaries, from this viewpoint, are expressions of the analyst's subjectivity. The clinical implications of this concept of psychoanalytic boundaries are demonstrated in the treatment of a severely regressed patient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Convergence and divergence in the characters of analyst and patient: Fairbairn treating Guntrip.

This article explores the intermingling of the analyst's and patient's personalities and examines the influence of this characterological mesh on the treatment and its outcome. The author argued that what is most salient is the configuration and type of convergence and divergence between their characters, and not just the degree of overlap between them. The presence of contradictions in the analyst's character may have focal significance for the analysand, depending on its relevance to the patient's own character and psychic issues. As a "prequel" to an earlier study (M. Crastnopol, see record 1999-05013-005) of the same patient's analysis with D. W. Winnicott, the author reviewed biographical material and a treatment record of Harry Guntrip's analysis with W. R. D. Fairbairn. She then developed a particular interpretive perspective on this material in order to illustrate the complexity of examining the critical impact of the analyst-patient fit on the analytic process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The nature of the patient's problems and how in psychoanalysis the individual works to solve them.

Describes the therapeutic process as the process by which the patient works consciously and unconsciously with the analyst to disconfirm pathogenic beliefs (PBs). The patient's psychopathology stems from PBs acquired in childhood from traumatic experiences with parents. PBs warn patients that if they attempt to gratify certain impulses or to seek certain developmental goals they will risk disruption of parental ties. Because of PBs patients develop fear, anxiety, guilt, shame, or remorse; institute repressions; and develop symptoms, inhibitions, and faulty object relations. In therapy, patients work to disconfirm PBs by (1) testing them in relation to the analyst in the hope of disconfirming them and (2) assimilating insight into PBs conveyed by the analyst's interpretations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)