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)     

"The best thing in me": The analyst's courage in clinical practice.

Clinical analytic work requires courage on the part of analyst and the analysand. Using a statement by Freud as the model, such courage is examined in a case illustration by T. J. Jacobs (2008). Along with professional courage, both commonplace courage and heroic courage are also described, with some dynamic roots of courage defined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The mystery of things.

Review of book: Christopher Bollas (Au.) The mystery of things. New York: Routledge, 1999, 203 pp.. Reviewed by Eileen A. Kohutis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reciprocal free association: Listening with the third ear as an instrument in psychoanalysis.

The focus of this article is the psychological processes occurring in the analysand and the analyst, and shaping the exchanges between them. These processes have been given by Otto Isakower the metaphorical name of the analyzing instrument while Theodor Reik used the metaphor of the third ear. In the spirit of the methodology of operationalism, the author was the first in 1984 to rename this process reciprocal-free association. The further focus is the status of free association as the foundation of psychoanalysis as method of psychological investigation, discovery (heuristics), and healing, even in its latter function, psychoanalysis contains additional, and equally essential, procedures, such as confrontation, reality testing, elucidation of ethical conflicts, logical analysis of premise and prejudice. But this does not mean mutual exclusion. Rather, such dichotomizing of the approaches to the analytic process reflects the fact of basic human archetypes, the cause of recurrent polarizations among analysts of poets versus pragmatists and scientists, those inspired by imagination, image and metaphor versus those guided by logic and literalness. A good method requires the conjoining of all the available approaches. (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)     

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 enigma of social support and occupational stress: Source congruence and gender role effects.

Research on the potential ameliorating effects of social support on occupational stress produces weak, inconsistent, and even contradictory results. This study of 117 employees, mostly from a southern U.S. hospital supply company, examined potential moderators that were theorized might reduce the confusion: source congruence (congruence between sources of the stressor and of social support) and gender role. Congruence between the sources of stressors and of social support appeared to make little difference in determining the moderating or buffering effect of social support on the relationship between stressors and strain. Gender role, however, may moderate the relationship between social support and individual strains such that more feminine people react more strongly and positively to social support than more masculine people do. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Other times, other realities: Toward a theory of psychoanalytic treatment.

Reviews the book, Other times, other realities: Toward a theory of psychoanalytic treatment by Arnold H. Modell (see record 1990-97902-000). This book is addressed to the psychoanalytically sophisticated reader. Its introduction and 10 chapters take the reader through a history of ideas that have been postulated to explain why psychoanalysis works. Interspersed are valuable comments by Modell that include his own original contributions to the discussion. Chapter 1 revolves around Freud and Nachtr?glichkeit. Chapter 2 illuminates the paradoxical relation between reality and illusions that is manifested in the analytic setting. The concept of reality and its various levels are examined in chapter 3. Chapter 4 discusses the neurobiological theories of Edelman, who postulates that memory is not isomorphic with past experience but a recategorization. Modell sees different levels of reality as corresponding to different forms of transference. He relabels transference neurosis as iconic/projective transference and the transference derived from the setting as dependent/containing transference. Chapter 5 amplifies his remarks on linear and cyclic time. Chapter 6 discusses interpretation and chapter 7 examines the concept of resistance. Other chapters deal with the patient's use of the therapist, with paradox and therapeutic dilemmas, and with various theories of psychoanalytic treatment. Modell tries to classify contemporary theories of psychoanalytic treatment but recognizes such attempts as little more than convenient fictions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A revised psychoanalytic conception of schizophrenia: An interdisciplinary update.

The psychoanalytic conception and treatment of schizophrenia is in need of fundamental revision because of (a) refinements in nosology which have separated out the borderline and affective disorders with which it had formerly been confused; (b) the development of newer psychoanalytic schools; and (c) the impact of various aspects of neurobiological research, the putative outcome of which seems to confirm that many, if not most, schizophrenics begin with a hereditary and/or congenital vulnerability to life and are disadvantaged in how they experience life, not only emotionally, but also neuroperceptually, neurocognitively, and neurobehaviorally. This contribution seeks to put schizophrenia and psychoanalysis in an interdisciplinary perspective by assigning the concept of disorders of psychical meaningfulness to the neurotic portion of the schizophrenic personality and of psychical meaninglessness to the psychotic portion of the personality. Whereas all psychoanalytic schools traditionally employ models that address meaningfulness, I suggest the employment of a newer model to deal with schizophrenia as a "disorder of self-regulation" (of meaninglessness), the latter being the neurobiological contribution. To the former I should like also to append the concept of a "disorder of interactional regulation" as its interpersonal complement in the sense of psychosocial, object relations, and systems theory interactions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

One role or two?: The function of psychological separation in role conflict.

Student athletes vary in how much they view their academic and athletic role identities as separate from and interfering with each other. The authors investigated the relation of these perceptions to psychological well-being in 200 intercollegiate athletes. Measures included role separation, interference, identity, and well-being. Correlations indicated that interference related negatively to well-being, whereas viewing the roles as distinct related positively to well-being. Regression analyses of demographic and role identity variables also showed a positive association between role separation and well-being, and a significant Separation×Interference interaction. Specifically, role interference was negatively related to well-being for those who viewed the two roles as distinct but unrelated for those who did not. The buffering effects of role separation are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Consensus in work role requirements: The influence of discrete occupational context on role expectations.

Although role theory has long described how expectations shape role behavior, little empirical research has examined differences among work role requirements and how features of the discrete occupational context may influence the extent to which role expectations are shared among role holders. The authors examined consensus in work role requirements from a sample of over 20,000 incumbents across 98 occupations. They found that consensus systematically decreased as work role requirements ranged from molecular tasks to responsibilities to molar traits. In addition, they found that consensus in these work role requirements was significantly influenced by the amount of interdependence, autonomy, and routinization present in the surrounding task and social contexts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Classic in Psychotherapy Integration Revisited: The Dynamics of Psychotherapy in the Light of Learning Theory.

Discusses the history of psychoanalytic treatment and the dynamics of psychotherapy. The essential psychodynamic principles on which psychoanalytic treatments rest have solid observational foundations: 1) during treatment unconscious (repressed) material becomes conscious; 2) the mobilization of unconscious material is achieved mainly by interpretation of material emerging during free association and by the patient's emotional interpersonal experiences in the therapeutic situation (transference); 3) the patient shows resistance against recognizing unconscious content; and 4) it is only natural that the neurotic patient will sooner or later direct his typical neurotic attitude toward his therapist. Current studies give encouragement and hope that we shall eventually be able to understand more adequately this intricate interpersonal process and to account for therapeutic successes and failures. In the field of psychotherapy the long overdue observation of the therapeutic process by nonparticipant observers is turning out to be the required methodological tool. At present, we are witnessing the beginnings of a most promising integration of psychoanalytic theory and practice of the psychotherapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Which way in psychoanalysis? The problem of suggestion in the postmodern world.

The postmodern critique of psychoanalysis resurrects the problem of suggestion in full force. Contemporary psychoanalysts rely on 1 or more of 6 related strategies to avoid this unfortunate consequence. However, as Freud recognized early on, such strategies alone cannot remediate this problem. Without a viable solution, practitioners must confront the possibility that their interpretations enjoy no hegemony over nonpsychoanalytic ones and that their therapeutic results may be indistinguishable from the effects of suggestion and influence that they ambivalently embrace. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Treatment of Obsessions.

This book provides background theory and research, and describes treatment techniques for a new cognitive-behavioural treatment for patients whose major or sole problem is obsessions (i.e., recurrent, unwanted thoughts, impulses, or images that the person finds unacceptable or disgusting). The reviewer's comments are as follows: (1) I liked the use of chapter summaries in the first two chapters and wish that this feature had been maintained throughout, (2) Although I very much appreciated that many of the necessary tools were included, I found the level of the language used in some of these to be quite high and likely unsuitable for patients with lower levels of education or intelligence, (3) I found the incorporation of case material throughout the book very helpful and appreciated the inclusion of more detailed case examples in Chapter 10; I wondered if the latter might have been better placed earlier in the manual and (4) My final criticism pertains to the fact that, as Rachman acknowledges, the causal role of catastrophic misinterpretation of intrusive thoughts in the etiology of obsessions has yet to be demonstrated experimentally, and there has yet to be an empirical test of the efficacy of this novel cognitive therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The postmodern turn in psychoanalysis: A critique.

In the recent literature, legitimate criticisms of some traditional psychoanalytic views have been transformed into untenable philosophical positions that do not constitute an adequate basis for psychoanalytic theory or practice. For example, skepticism toward the therapeutic value of insight and self-knowledge has been transformed into a philosophical position that rules out the very possibility of discovering truths about the mind. According to this view, rather than uncovering and discovering what is in the patient's mind, the mind is "interpretively constructed." The author argues that all of the difficulties of traditional theory identified by "new view" theorists do not obviate the need to recognize the existence of the patient's psychic reality independent of interpretive constructions and to attempt to understand that reality as fully and as accurately as possible. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond insight: An additional necessary step in redressing intrapsychic conflict.

It is axiomatic in psychoanalytic thinking that many forms of psychopathology are rooted in unconscious conflict over libidinal and aggressive impulses. The following treatment corollary of this proposition comprises the heart of this paper: If these unconscious conflicts are to be securely overcome in psychoanalytic treatment, beyond gaining insight, the analysand must become more accepting of the impulses that had been warded off--i.e., find modulated and regulated avenues of impulse expression. Both the presence of a nonjudgmental analyst and certain aspects of the psychoanalytic process foster such an outcome. Whereas for some analysands that is sufficient for achieving this goal, for others, specific interventions are necessary, ranging from particular kinds of interpretations to the use of parameters. These interventions are discussed with consideration given to both their potential yield and their dangers, and with suggestions made as to how the latter can be minimized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contemporary American psychoanalysis: A profession? Increasing the role of research in psychoanalysis.

The simmering crisis confronting American psychoanalysis today is, in part, a function of fundamental theoretical and clinical disagreements within psychoanalysis itself. Psychoanalytic training, which conveys the special knowledge of our profession, and its application to techniques of treatment have become fragmented and frayed; boundaries have lost definition and our qualification as a profession is vitiated. Our diminished status is reflected in reduced public support and our smaller share of the patient population. Debate seems unable to resolve these disagreements. Acknowledgment of this reduced status creates the need and the opportunity for an increased role for research in psychoanalysis and the development of an analytic research enterprise capable of exploring for empirical resolutions of basic questions and disputes. Such a concerted effort to define the psychoanalytic enterprise through empirically supported basic tenets is necessary to avoid further dissipation of the markers of our psychoanalytic identity, both as individuals and as a profession. (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)     

The role of unconscious pathogenic beliefs in agoraphobia.

Agoraphobia can severely constrict the life of those who suffer from it. Control-mastery theory is a cognitive psychoanalytic theory that posits that symptoms are caused and maintained by unconscious pathogenic beliefs. Two cases are discussed in detail to support the hypothesis that agoraphobic patients suffer from 2 pathogenic beliefs: The world is a dangerous place that punishes assertiveness and they don't deserve to have a better life. The role of unconscious pathogenic beliefs may serve as a bridge in explaining both the efficacy of cognitive-behavioral therapy as well as the usefulness of longer term psychodynamic treatment in resolving the often significant residual symptoms of these patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Analysis of Meaninglessness.

Patients who are severely inhibited in their capacity to free associate and reflect on their associations present a technical challenge. Such inhibitions threaten the treatment with a form of communication breakdown. There is often a sense of futility and a sense that someone must be to blame for the treatment impasse. Efforts to interpret such severe inhibitions often result in intensification of the impasse. Working through such enactments is facilitated not only through accurate psychodynamic understanding but also through a willingness to engage in some degree of spontaneous emotional engagement, self-disclosure, and mutual analysis. When the patient is in a state of psychic equivalence, a particular quality of relational experience is sometimes required for the patient to perceive how external and internal reality are not necessarily equivalent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)