Mental imagery in psychoanalytic treatment.

Mental imagery techniques may facilitate the therapeutic process by stimulating patients' insight into unconscious dynamics, by helping them uncover and master warded-off affect, and by enhancing the clinician's empathic contact and access to countertransference. The history of imagery techniques in the psychoanalytic movement and the effect of these techniques on the traditional psychoanalytic method are reviewed. A conceptual framework based on the theory of primary and secondary process suggests spontaneity, experiential scope, associative elaboration, and object impact as four dimensions for the clinical evaluation of imagery experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence and vulnerability in psychoanalytic supervision and treatment.

This article suggests that struggles regarding personal influence are critical to understanding the supervisory process and the process of change in psychoanalytic treatment. By the nature of their role, supervisors and therapists seek to influence. Yet, they also fear having undue influence. Patients and supervisees, although seeking influence and help, are also wary of the vulnerability to another individual that such influence may entail. The essential question addressed in this article is how the kind of personal influence that patients and supervisees want and need—and also fear—can be enabled, given the conflicts about influence of all parties in the process. It is suggested that a process of reciprocal vulnerability to being influenced, in both the treatment and supervisory relationships, enables an atmosphere of safety and the possibility of having an impact in return. Examples from clinical supervision illustrate these points. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychoanalytic treatment of narcissism.

This paper discusses the need for change in emphasis from metapsychological debate to a sharp clinical focus on the complex nature of narcissistic pathology. Narcissism is viewed as a dimension of psychopathology found at all levels of psychic functioning, at the core of which are characteristic ego and superego deficits around self-cohesion, self-continuity, and self-esteem regulation. It is argued that, if the definition of conflict is not viewed too narrowly, traditional Freudian or ego-psychological techniques are applicable and that the treatment of narcissism does not require a new theory, separate from that of object relations. Clinical material is presented to illustrate that all psychological phenomena are over-determined and contain aspects of unresolved preoedipal and oedipal conflicts. There are critical selfhood aspects at each stage of development which must be understood and interpreted, in addition to the traditional structural conflicts. It is stressed that highly developed skills in listening and in interpreting are required in order to discern the narcissistic and object-relations aspects of the clinical material and that the countertransference around the analyst's own narcissism needs particular attention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of concordance and complementarity in psychoanalytic treatment.

Heinrich Racker (1968), in his seminal work on countertransference, highlighted the importance of concordance and complementarity in the countertransference. The present article argues that concordant and complementary identification are ubiquitous in the organization of experience and in human relationships, and that insufficient attention has been given to the role that these identifications play in the treatment process. Self psychology and projective identification were critiqued in relation to how they either avoid recognition of complementarity or reduce complementarity to concordance. The article concludes with a reanalysis of the patient–nurse relationship in Ingmar Bergman's Persona, dynamics that had been previously described by Otto Kernberg (1975) as projective identification and critiqued by Robert D. Stolorow and George E. Atwood (1992). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Free association and the division of labor in psychoanalytic treatment.

Although Freud considered the rule of free association to be fundamental, he was tentative about the recommendations he made concerning other aspects of analysis. Three quarters of a century later, there is still no formal theory of the working arrangements in treatment, and even the fundamental rule is considered by analytic clinicians to be optional. I portray therapy as a dyadic social system and examine its primary task, boundaries, divisions of labor and authority, and culture in order to weigh the importance of the fundamental rule to task achievement. I find several advantages to making free association a role requirement upon the patient, including, inter alia, the freedom it provides the therapist for relaxed observation, counterassociation, and thought. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chess: A psychoanalytic tool in the treatment of children.

Proposes a theoretical rationale for the clinical application of chess instruction to the psychoanalytic process in working with inner city children and adolescents who may present particular resistance to the focus on verbal communication in traditional therapy. The chess pieces are seen as embodying parental symbols and the competition of the game is seen as symbolizing Oedipal issues. Transference phenomena in the relationships of students to the instructor are discussed and learning effective strategies of play is related to developing impulse control. A case study is described of an aggressive male pre-adolescent special education student who benefited from this intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

New perspectives on development and their implications for psychoanalytic treatment.

Reviews the book, Psychoanalysis and infant research by Joseph D. Lichtenberg (1983). The burgeoning field of infant research has burst through the seams of our traditional view of infants. We now know that neonates are far more aware of their environment, more capable of eliciting responses from people, and more differentiated in their responses to caretakers and to a variety of external stimuli than we had ever believed. In part, this new knowledge has been gained through clever, creative experimentation by academic researchers. Experiments have been devised which are simple enough for neonatal responsiveness, yet offer relevant information about the infant's learning, cognitive, and emotional capacities. Joseph Lichtenberg's book, Psychoanalysis and infant research, presents this rich body of research. Were he content to offer us this new and absorbing view of the neonate, that alone would make the book interesting and worthwhile. Lichtenberg, however, is more ambitious. He sees important implications of infant research for various aspects of psychoanalytic theory and believes that a careful reading of the infancy data will "lead to reexamination of our theory" (p. 27). While the reviewer thinks there is much that infant research can offer to inform psychoanalytic theory, more empirical data are clearly needed from this area as well as from clinical research in the psychoanalytic setting. Lichtenberg deserves our gratitude both for calling our attention to some of the most important research findings that have emerged to date and for directing us to consider the implications of these findings for psychoanalytic theory and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Readiness for psychoanalytic treatment in late adolescence: Developmental and adaptive considerations.

Clinical experience during two and a half decades in a university mental health service suggests that late-adolescent college students do not readily avail themselves of the opportunity for longer term psychoanalytic psychotherapy, even when such treatment is quite accessible. At the same time, late adolescents do make significant use of psychological services for briefer contacts. The author addresses the intrapsychic dynamics described in the literature and the impact of the relationship that the late adolescent develops toward the adult environment on readiness for treatment. An adaptive framework is proposed, and the author discusses the type of clinical services that are most suitable for late-adolescent patients, including problems inherent in time-limited treatments and the importance of establishing a collaborative alliance with the late-adolescent patient from the outset of the initial evaluation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conflict and somatization: psychoanalytic treatment of the psychophysiologic response in the digestive tract

Somatization of intrapsychic conflicts, as manifested in the mouth, the stomach, the small intestine, the large bowel, and the anus, is described in this long-term study of the psychoanalytic treatment of three patients with peptic ulcer, regional ileitis, and ulcerative colitis respectively. The theoretical and practical aspects of treatment are considered, and the efficacy of and indications for psychoanalysis as the treatment of choice are discussed.     

Diversity and direction in psychoanalytic technique.

Review of book: Fred Pine. Diversity and Direction in Psychoanalytic Technique. New Haven, CT: Yale University Press, 1998, viii + 234 pp. Reviewed by Joseph W. Slap. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Creativity in the psychoanalytic process

E. coli catalase (HPII) wild type and mutant enzymes (heme dcis-containing) were examined (i) to study the role of a distal haem cavity residue, asparagine-201, in high spin ligand binding and (ii) to compare the differences in this binding between heme d and protoheme enzymes such as that from beef liver (BLC). High spin fluoride complexes were formed by all three HPII catalases examined, wild type (201 asn) and 201gln and 201asp mutants, but with a lower fluoride affinity than that of BLC. The binding of fluoride was pH-dependent, indicating that a proton is bound as well as a fluoride anion. HPII 201glu and 201 asp mutants showed lower affinities for fluoride than did wild type, unlike their reactions with cyanide which are essentially independent of the nature of residue 201. The equilibria and rates of fluoride and formate binding to BLC were reexamined. The rates of reaction with formate were similar to those reported previously. Dissociation rates for fluoride-catalase are higher than for formate suggesting that the latter may be bound differently. High spin complexes between formate and all three HPII forms showed a substantially higher affinity than that of BLC for HPII wild type and progressively lower affinities for the two mutants. As with fluoride the reactions were pH-dependent, indicating that a proton is bound together with the formate anion (or that undissociated formic acid is the ligand). The known structures of the heme groups and heme pockets involved are discussed. Formate may be bound by secondary H-bounds within the heme pocket in both heme dcis and protoheme enzymes. The nature of the heme pocket and the heme access channel may be more important than the chemical nature of the prosthetic group in controlling both high spin ligand interactions and reactions with the substrate hydrogen peroxide.     

Considerations in the psychoanalytic treatment of men who were sexually abused as children.

Examines the literature on sexually abused men and illustrates with clinical examples from individual and group psychoanalytic practice the themes that emerge in working with them. Sexual abuse situations with boys are considered in 3 groups: those involving penetration, those involving inappropriate tactile contact, and those involving noncontact seduction and excitation. The boundary violation inherent in all of these situations is crucial in the treatment of the man who has been abused, as is the familial context of the abuse. Sexual orientation and gender identity, abuse in a familial context, love and sexuality, and transference and countertransference are discussed. For the analyst treating men who were sexually abused, there may be feelings of being overwhelmed by the seductive energy in the analytic relationship and also wishes to reel back and deny the horror of the material being discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Modifications in the psychoanalytic treatment of adults who "act-out."

Describes modifications of the psychoanalytic approach to benefit adults who, because of acting-out behavior, are considered not amenable to psychotherapy. Case profiles of 2 males, one who could not be faithful in marriage and the other who was involved in dangerous promiscuity, are presented as examples. Four principles (avoiding limit setting, extending perspectivism, maintaining active interest, and setting achievable goals) for working with such patients are presented. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)