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)     

How anti-gay bias compromised a treatment: A commentary on Meissner (2006).

Comments on the original article, "Time on my hands: The dilemma of the chronically late patient" by W. W. Meissner (see record 2006-20697-003). Meissner's paper purports to examine a chronically late patient. What emerges instead is an example of antigay analytic bias that is rarely acknowledged in this era of increasing acceptance of nonheterosexual orientation. Fr. Meissner described his use of coercive interpretations and collusion with the patient to suppress unwanted expressions of and activities around sexual orientation. This commentary briefly recapitulates the recent history of psychoanalysis' awakening over issues of sexual orientation and attempts by the profession's major figures to expand their understanding of human sexuality. The opportunity to reexamine an historical homophobic stance is used in this commentary to produce a more parsimonious interpretation of the patient's chronic lateness and other issues around contamination of the treatment by antigay analytic bias. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

"Screen time: Clinical notes regarding Meissner's (2006) chronically late patient": Reply to commentary by M. H. Spero.

Responds to the comments made by Moshe Halevi Spero (see record 2008-00996-014) on the current author's original article, "Time on my hands: The dilemma of the chronically late patient" (see record 2006-20697-003). First of all, I would like to express my gratitude to Professor Spero for his thoughtful, penetrating and thought-provoking commentary on my chronically late patient. Whenever one's efforts elicit such a sensitive and probing reflection, the effect can hardly be anything but gratifying. Spero's reflection brings to bear a deconstructive perspective that effectively captures the uncertainty, ambiguities, and conflicting pressures created in an analytic process that had become abbreviated, fragmented, diffused, frustrated, and constantly hovering seemingly on the brink of disruption. His approach thoughtfully probes the periphery and penumbra of significance surrounding the playing out of events in this analytic process, and his inquiry thus brings into focus a number of salient issues that could not be engaged or whose meaning could not be effectively ascertained because of the dissolute quality of the analytic effort. (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)     

Time on my hands: The dilemma of the chronically late patient.

In this article the author discusses the problems and dilemmas created by patients who are chronically late for analytic hours or frequently absent from them. The discussion focuses on a single case study, in which this phenomenon was a predominant feature of the analytic process. The author explores some of the issues, dynamic and defensive, underlying such behavior as well as motivational components involving unresolved oedipal issues and powerful unsatisfied narcissistic needs. The temporal difficulties of patients such as this one demonstrate the role of time as a point of conjunction of aspects of the analytic relation involving the temporal dimension of the real structure of the analytic situation and its intersection with transferential and alliance considerations. The analytic task is to balance the temporal requirements of the analytic process against the array of the patient's infantile and narcissistic needs on one hand and legitimate claims for autonomy and freedom on the other. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The analyst's vision of the patient and therapeutic action.

As psychoanalytic therapy shifts from a conflict resolution theory to a model of self-realization, the analyst's vision of the patient takes on a more prominent role in the process. This article builds on H. Loewald's (1960/1980) concept of the analyst as "behind" because he or she can only build from the patient's spontaneous productions and yet "ahead" in that the analyst goes beyond the patient's material to construct an image of who the analysand can become. In this way, the future becomes a prominent component of the analytic process. The famous case of Anna O. is used to demonstrate the deleterious effects of failing to include the analyst's vision in the treatment process. This case is contrasted with the contemporary treatment of a young woman, a case that illustrates the use of the analyst's vision in the conduct of psychoanalytic 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)     

A new analytic dyad: homosexual analyst, heterosexual patient

The paradoxical thesis is presented that the extraordinary aspect of the analytic experience of a homosexual male analyst and his heterosexual male analysand is that it was ordinary, that the fundamental processes of transference, countertransference, and analysis of defense and resistance were determinative. The unique variations of these processes with this particular patient are explored. The patient entered treatment unaware of the analyst's homosexuality, which he discovered during the analysis. The course of this discovery, its transformations, its defensive uses, its transference meanings, and its fate in the termination are delineated. Through viewing the patient's reactions to the analyst's homosexuality as potential entry points to the transference, the analytic process was enhanced and facilitated.     

The art and science of dream interpretation: Isakower revisited

Dream imagery presents a special opportunity to lead patient and analyst through the patient's network of memories to the discovery of unconscious memories that have complicated and interfered with the patient's attempts to resolve important life problems. This is an important, perhaps indispensable, first step on the way to successful working through to solutions that are more rational and realistic than the neurotic symptoms that brought the patient to treatment in the first place. Theoretical and empirical rationales are presented for a technical approach to dreams that takes full advantage of the special opportunities that working with dream imagery provides: for deepening the psychoanalytic process and for acquainting the patient with principles of mental function applicable to aspects and phases of the analytic process that he/she will encounter as the work progresses.     

A critical evaluation of current conceptions of transference and countertransference.

The author's main thesis is that, quite ironically, in reacting against the classical blank screen view of the analytic situation, a new and more subtle version of the blank screen analyst, or at least of the blank mirror analyst, has emerged. In this new version, the analyst's countertransference reactions tend to be seen as a virtually unerring guide to the patient's mental contents. Some difficulties with this new point of view are discussed, and a critical discussion of H. Racker's (1968) concept of complementary identification and the much used concept of projective identification is included. (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.     

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)     

Bearable and unbearable guilt: a Kleinian perspective

Material is presented from four analytic sessions with a patient who seems unable to bear guilt. The first two illustrate defenses against guilt; the last two show the incipient experience of guilt and, finally, the ability to suffer conscious guilt. The author questions interpretations that address defenses against guilt but fail to help the patient bear the guilt. Such interpretations can make the analyst prey to a sadomasochistic enactment in the transference whereby the patient expiates the guilt and reverts to not recognizing what he or she does to objects. The ability to bear guilt is increased by a diminution of the patient's destructiveness and by the mobilization of love.     

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)     

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)     

Confrontation analysis in groups: Goals of treatment.

Confrontation analysis (CA) is a psychotherapeutic system that provides a conceptual framework and techniques in which specific goals of treatment may be sought. In this system, confrontations are utilized to help the patient become aware of perceptual and behavioral distortions; the patient's reactions to these confrontations are then analyzed to help modify pathological manifestations. Transference and countertransference phenomena are focused on as the vehicles for understanding past and present dynamics of the self, while the interaction between patient and analyst in individual therapy, and between patient, analyst, and group in group therapy, is perceived as the central process for working through basic conflicts. Central to CA is the self (or ego), which is regarded as the primary agency where transactions between the individual and the world, and within the individual, occur. Treatment of the self is based on the notion that basic conflicts related to pregenital dependency strivings produce pathological developments in major areas of the functioning self. CA espouses a theoretical formulation that views the patient's maladaptive patterns as originating from disturbances in the early mother–child relationship. Group structure utilizing CA techniques and strategies, with a special emphasis on interaction that does not exclude the therapist, provides an unusual contextual framework where central issues in living may be understood and modified. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The concept of enactment and theoretical convergence

Classical analysts have recently become interested in the constructive use of countertransference. Some have extended the traditional conception of transference enactment to include the analyst's countertransference enactments. That is, the analyst may unwittingly actualize the patient's transference and, together with the patient, live out intrapsychic configurations. Awareness and interpretation are likely to occur only after there has been a transference-countertransference enactment. Some classical analytic writers have concluded that such experience may be both inevitable and a productive means of achieving analytic goals. This point of view corresponds closely to positions long expressed by interpersonal psychoanalytic contributors, thus signaling a trend toward a partial convergence of these two historically divergent theories of therapeutic action.