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)     

Countertransference in child psychoanalytic psychotherapy: The emergence of the analyst’s childhood.

The author focuses on a particular type of countertransference with children—the emergence of the therapist’s childhood memories and experiences in child psychotherapy. The revival of these childhood recollections in the analyst is not a barrier or sign of pathology as previously held, but rather in some cases a vital resource that may potentially deepen and facilitate analytic work. The therapist’s memory and attendant fantasies, physical/sensory experience, and affect states in the context of the childhood memory may afford the analyst the opportunity to not only make contact with his or her “self” as a child, but also to further symbolize these states of mind and use them in the exploration of the child patient’s mind. Through intersubjective exchanges with the patient, the analyst’s childhood memories are given new meaning in the context of the therapeutic work with the child patient. The author highlights the uniqueness of countertransference with children as compared with adults. A detailed clinical vignette is presented, organized around the arrival of a memory from the analyst’s childhood and how the analyst made use of it in the transference/countertransference field. (PsycINFO Database Record (c) 2010 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)     

Countertransference disclosure and the conceptualization of analytic technique

Most discussions of countertransference disclosure have focused on points of impasse. Here, I will discuss countertransference disclosure in which the analyst attempts to make explicit to the patient how the analyst experiences something during an analytic session that differs from the way the patient experiences the same moment. The analyst presents his observation as something for the patient and analyst to work on together, with the aim of arriving at further understanding. In a clinical example, I suggest a way of comparing uses of countertransference that relate to other approaches in analytic technique. Since the analyst's disclosure evokes questions regarding asymmetry and anonymity in the analytic process, I will briefly elaborate these dimensions.     

Screen time: Clinical notes regarding Meissner's (2006) chronically late patient.

This communication is a commentary on William W. Meissner's presentation (see record 2006-20697-003) of a patient who chronically came late for sessions. The time duration of analytic work-relatively restricted per hour yet potentially limitless in overall duration-represents an existential paradox that is fundamental to the basic representational qualities of mental experience, and inherent in a mute way in the analytic frame. It is to be expected that the latent temporal elements of the patient's conflicts will inevitably challenge this aspect of the frame, subtly coercing patient and analyst to recreate these novel dimensions. If the analyst is too cautious regarding the inevitability of countertransference reactions to such a patient, important developmental opportunities may be missed. I suspect that the chronic lateness and absence that characterized the work with this patient screened an early, nonmentalized trauma that had torn a hole in the foundations of the patient's sense of time, and was inadvertently expressed by Meissner in an entirely atypical manner. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immigration and the psychodynamics of class.

Numerous psychoanalytic contributors have theorized about the substantive role played by cultural factors in organizing individual identity. In addition to individual and family dynamics, issues related to class, race, religion, and other cultural themes also exert a vital presence in the treatment setting. These social forces define experience in profound ways from which it is impossible that form an inextricable part of an individual's psychology. Societal values, norms, and forces are carried and represented, forming an ever-present backdrop to our psychological lives. They thus become, perforce, part of the treatment process whether or not the therapist or analyst is aware of their presence. In prior work I have explored the topic of the immigrant's construction of self as it relates to social class (Ainslie, 2009). I argue that one of the variables that shape an immigrant's psychology is his or her social class position in his or her country of origin. In the present contribution, I seek to extend this exploration of the topic of social class and the psychology of immigration through three vignettes that capture aspects of how social class becomes represented in the experience and therapeutic treatment of immigrants. (PsycINFO Database Record (c) 2011 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)     

Patient collaboration as a criterion for the therapeutic alliance.

In this article we show that a focus on patient collaboration, as a marker for the therapeutic alliance, is advantageous not only for theory and research but also for clinical practice. This point of view in no way minimizes the importance of the therapist's activity or the clinical significance of the interaction between patient and therapist. Rather, it focuses attention on how the therapist's personality, skill, and technique interact with the problems the patient brings to psychotherapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychoanalysis conducted at reduced frequencies.

This paper explores the clinical indications for an optimal psychoanalysis conducted at reduced frequencies. Among other purposes psychoanalysis is an engagement that serves to demystify experience. The structure of multiple session frequency applied a priori and in the absence of other considerations may contribute to mystification of the analytic process itself. Particularly for those patients presenting with limited ego-capacity for reflection, impulsive or compulsive behaviors, inhibition of thinking processes, blunting of emotions, and rudimentary capacity for therapeutic cooperation, analyses of multiple frequencies can contribute to false compliance or resistance. Clinically the frequency of sessions can be determined on an empirical basis. An analysand's ability to self-reflect occurs in the same measure as one's tolerance for emotional contact with the analyst and the unconscious. An optimal psychoanalysis understood as a maturational process is conducted initially for some clinical varieties of transference at reduced frequency, which is then expanded over time as the person's capacity for thoughtful self-reflection and interpersonal contact with the analyst develops. In this way actual unconscious processes are privileged over taken-for-granted therapeutics and addressed as an empirical reality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mind, brain, and self in psychoanalysis: Therapeutic implications of the mind-body relation.

Theoretical and empirical findings regarding the mind-body relation and its integration within a concept of the self-as-person lead to certain therapeutic implications and applications. The mind-set of the analyst or psychotherapist regarding the integration of mind-body can have important reverberations, which can dictate decisions for therapeutic intervention and management. Implications for conceptualizing technical modifications in analytic therapy are suggested. Conceptualization of mind and brain operating as an integrated and functional unity contribute to better understanding aspects of mental functioning that remain beyond the reach of conscious awareness and direct therapeutic processing. Particular attention is paid to the issue of combining medications clinically with psychotherapy and psychoanalysis. Future integration of psychoanalysis with advancing trends in therapeutic intervention and with rapidly expanding neurobiological understanding of mental actions as related to brain activity may require a deepening awareness of complexities of the mind-body relation and a more analytically meaningful resolution of the problem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Significance of the unconscious plan for psychoanalytic theory.

Compares the assertions of J. Weiss et al (1986) regarding the role of the patient's unconscious plan in analytic treatment with other contemporary theories. According to Weiss et al, the analyst listens, albeit unconsciously, to the patient with respect for the patient's capacity to spell out his or her goals, the blocks to achieving these goals, and what the analyst needs to do and avoid doing for these goals to be accomplished. Differences and similarities of the plan model are discussed in reference to the ideas of R. Emde (see record 1991-13225-001), R. Schafer (1983), R. Stolorow et al (1987), and J. Bowlby (1988) concerning developmental psychoanalysis and the active patient; action language, excessive claiming, and beliefs; self psychology; and attachment models. The plan is offered as one solution to the theoretical, cultural, and clinical problems that currently afflict psychoanalysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The emotionally engaged analyst II: How emotions impact analytic process as illuminated by dynamic systems theory.

A dynamic systems theory of emotion is presented and used to reveal the complex emotional interactions that create the emotional experience of the patient and of the analyst and that constitute, shape, and direct the analytic process. Through the analysis of clinical vignettes, the dynamic emotional processes that engender intense relational moments, enactments, stalemates, and resistances between the patient and the analyst, as well as sequences of disruption, repairs, and mutative change, are illustrated. The flow of emotional energy that vitalizes the analytic interaction and influences the meanings attributed to the patient-analyst interaction is delineated and related to the analyst's emotional engagement of the patient and to the central position of this emotional relationship in facilitating therapeutic change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cohesion in group psychotherapy.

Insight into the therapeutic relationship in group psychotherapy requires an understanding of the treatment context. Cohesion is defined as the therapeutic relationship in group psychotherapy emerging from the aggregate of member leader, member-member, and member-group relationships. Using this definition, evidence for the relationship between cohesion, patient outcome, an treatment processes is reviewed. Six empirically supported principles that undergird the development and maintenance of cohesion are presented touching on pregroup preparation, ear group structure, leader interaction, feedback, leader modeling, and member emotional expression. The limitations the present research are discussed; leading to opportunities for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A perspective on child psychoanalysis 1994: The recognition of relational theory and technique in child treatment.

The central assertion of this article is that child psychoanalysts have been moving toward relational theory and practice in recent years. However, the lingering influence of drive theory and associated analytic technique is evident in a common tendency to ignore the impact on the patient of what the analyst does and says in the analytic interaction. Clinical examples illustrating this point are taken from the published work of Freudian, Kleinian, and Winnicottian analysts. Discussion of the cases focuses on explicating the points at which the analytic work presented does or does not focus on the here-and-now interaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The anatomy of psychotherapy.

Reviews the book, The anatomy of psychotherapy by Lawrence Friedman (see record 1988-97848-000). The authors' aim is to clarify the various theories of psychoanalysis from Freud to the current and to examine in depth the personal features of the analyst in the context of his/her work. With a knowledge of the entire range of psychoanalytic literature rare with most theorists or practitioners, the author reviews the philosophical developments of Freudian theory. He includes in this review some of the frictions, disputes and subtle disagreements within the classical analytic tradition. He then proceeds to describe the most significant of the contemporary deviations from classical theory (e.g., object relations, interpersonal theory, self psychology, action language) and compares and contrasts them with each other. Friedman has long been a commentator on contemporary psychoanalytic developments and he has adapted his many articles into this work. The book itself is organized into six sections, focusing on the personal and theoretical. It is well written but quite dense. Much concentration is needed. I believe that one must have an interest in psychoanalytic theory as well as a rather sophisticated appreciation of it to truly enjoy this book. It is long and detailed and I imagine difficult to get through without an intrinsic interest in the "anatomy" of psychoanalysis. (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)     

Repression, accessibility, and the translation of private experience.

This article explores two underlying assumptions of the structural deficits approach to psychoanalytic psychotherapy (e.g., Gedo, 1984; Kohut, 1984); (a) that the analyst must gain a knowledge of the patient's intrapsychic capacities through empathetic processes, and (b) that inaccessible memories are split off or repressed from expression within the analytic hour because the patient lacks the adequate intrapsychic capacities and structures to tolerate their associated affects. These assumptions are discussed within the context of contemporary views of multiple modes or forms of memory, repression, and the question of accessibility. It is concluded that the mechanisms of repression can operate at the stages of initial encoding as well as the retrieval stage and, consequently, that traumatic memory contents appearing to be relatively inaccessible may be so (a) because of active repression at the time of retrieval or (b) because a minimal number of associative connections have been established with other contents in memory. Thus, a greater portion of private experience is preconsciously available than would be suggested by the deficits approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Clinical interaction and the analysis of meaning: A new psychoanalytic theory.

Reviews the book, Clinical interaction and the analysis of meaning: A new psychoanalytic theory by T. Dorpat and M. Miller (see record 1992-98407-000). This text views psychoanalysis and psychoanalytic psychotherapy from the perspective of the newly proposed concept of "Meaning Analysis." The authors purport to advance psychoanalytic theory and technique by taking a fresh perspective on two important aspects of analytic encounter: the interaction between the analyst and analysand (therapist and patient) and how interactions in this relationship affect transference and countertransference. This book also examines the analysis of meaning and how treatment can assist in the understanding and reconstruction of client beliefs. The authors present a reanalysis of Freud's theory and the goal of the book is to elucidate the "flaws" in his work. The reviewer believes that many readers will be intrigued by the criticisms of Freud and the blending of more recent research into analytic models. This book is recommended for both analytically oriented therapists and interested readers who want to learn more about analytic treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural dimensions of intersubjectivity: Negotiating “sameness” and “otherness” in the analytic relationship.

The cultural diversity of Western society has created an increasingly complex psychoanalytic intersubjective field. Cultural, class, racial, and familial dimensions of experience can never be separated in the psyche of the patient or analyst or in the analytic relationship. But the melding of these influences results in particular meanings for each patient, analyst, and analytic couple, and may be crucial to address for authentic connection and change to occur. A clinical case is presented in which uniquely melded cultural, class, and psychological meanings became enacted between patient and analyst, stimulating unexpected feelings in both, which enabled the emergence of a bridge across an apparent gulf of “otherness.” (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Analytic effectiveness.

This report summarizes a panel that addressed from a pragmatic point of view the concept of analytic effectiveness. Leston Havens defined effectiveness in terms of the personal qualities of the analyst, suggesting that the fate of treatment depends on who the analyst is. He illustrated this idea with examples drawn from Harry Stack Sullivan, Elvin Semrad, and Havens's own analysis. Stephen Mitchell discussed effectiveness in terms of the interplay of directiveness and nondirectiveness in psychoanalysis and offered an alternative perspective to the classical model for thinking about these modes of intervention. Owen Renik addressed the issue of analytic goals, emphasizing the importance of the analyst openly discussing his or her treatment goals to explore the patients' implicit goals and to confront hidden assumptions about authority that can impede analytic work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)