Summaries and Abstracts

An Analyst's Regressive Reverie.

Int. Journal of Psycho-anal., 68; 271-277, 1987.

This is a report of an unusual psychoanalytic occurrence where both the patient and the analyst experienced dream-like states during the same session. The analyst's attempt to explore this reverie in a therapeutic way highlights some of the complex transference-countertransference issues involved in this apparent empathic "lapse".

There also have been reports regarding significant therapeutic clues available from the analyst's daydreams (Greenson, 1970; Thomson, 1980; Flannery, 1983,; Strean, 1984) and a rather humorous anecdote about a tactless analyst falling asleep during a session (Loewenstein, 1951). ; Somnolence, on the analyst's part, is usually considered a countertransference reaction to either the patient or the material being presented. Not all experiences of the analyst necessarily should be regarded as problematic countertransference in its classical sense.  The phenomena of the patient's unconscious anaclitic needs, coming together in concert with the analyst's diatrophic function is part of a therapeutic experience. This may assume various clinical expressions within the analytic setting, for example shared reveries or even sleep might be considered as a mutually regressive empathic situation.

Summary

During an analysis the patient's impulses stimulate corresponding fantasies in the analyst. It is the analyst's work to experience, organize and synthesize aspects of his empathic and intuitive responses into relevant interpretations and constructions for the patient. Intersubjectivity concerns itself with the study of the shared experienexperienexperienexperiences, mutual feelings and fantasies between the patient and his therapist.

A psychoanalytic session is described where both the analyst and analysand experienced a dream-like state associated with the theme of childhood illness. The analyst's countertransference took the form of a hypnagogic reverie concerning a dying boy's plea for his help, while the analysand's transference reaction was to re-experience the analyst as the negligent anaclitic father and himself the neglected child. The analyst's frustrated reverie and the patient's frightened angry response was a regressive expression of what previously had been unconsciously shared, but not totally congruent fantasies.

Although this was initially a disillusioning experience in the analysis, with attempts at working through, the analysand was subsequently freer with his associations and positive feelings. There was also recovery of associated childhood illness experiences. It is suggested that these transient periods of altered consciousness provided a shared experience that was eventually analyzable and therefore therapeutic.

This paper considers the interaction between latent transference and countertransference fantasies during analyses. A clinical vignette, illustrating the vicissitudes of empathy is explored primarily from an intersubjective point of view.

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The Incidence and Significance of Perceptual Qualities Noted in the Reported Dreams of Anorexia Nervosa Patients.

Can. J. Psychiatry, Sept.,36; 517-520, 1991.

Abstract

Anorexic patients' recalled dreams were elicited and recorded using a standardized sleep questionnaire which concerned itself with the perceptual qualities and affects remembered in their dreams. There were consistent findings of infrequent dream recall, less color dreaming and less pleasurable themes among the anorexic subjects than was noted in the normal controls. Anorexics frequently saw themselves in their dreams as having a distorted body (especially belly enlargement), looking younger and they also experienced dysphoric food and hunger scenarios.

The evaluation of an anorexic patient's dream profile and its subsequent changes in both sensations and the frequency of reported dreaming, may have diagnostic and as well as prognostic importance in the therapeutic assessment of anorexia nervosa.

Summary

Anorexic patients' recalled dream profiles show a reduction in dream frequency and disturbances in sensations compared to the normal controls. In all our studies there were consistent findings of infrequent dream recall, less color dreaming and less pleasurable themes among the anorexic subjects than was noted in the normal controls. Anorexics frequently saw themselves in their dreams as having a distorted body (especially belly enlargement), looking younger and they experienced dysphoric food and hunger scenarios. The findings of lack of color, infrequent dream recall and dysphoric affects (particularly hunger) may indicate an impoverished, restricted personality regardless of whether or not the patient is symptomatic of anorexia at the time of testing. The findings of body distortions along with perceptual poverty in reported dreams often coincide with the primitive personality characteristics and dysthymic inhibition as seen in anorexia nervosa. Anorexic patients appear to have differing deficit symptoms ranging from neurotic to borderline psychopathology but characteristically they avoid intrapsychic exploration and experience such as unpleasant and/or irrelevant. These dreaming deficits can be elicited by exploring the perceptual characteristics of the patient's dream recall. An inquiry concerning specific features of the patient's reported dreamlife should be considered an integral part of every anorexic patient's assessment.

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Erotic Transference.

Can. J. Psychiatry, Vol.31; 323-327, May 1986.

Patients may experience erotic feelings towards their therapists during psychoanalysis. Such reactions are not dependent upon the therapist's qualities or even necessarily the form of therapy undertaken. They are manifestations of the patient's fantasy life based on previous relationships. These transferences may be a transient re-emergence of the patient's earlier sexual feelings or indicate intractable love demands which can bring about a non-therapeutic stalemate. Therefore such erotic feelings are expressive of a spectrum of emotions from common mild sexual interest through uncommon intense pathological erotic attachment.

Summary

Erotized transferences may manifest themselves in widely varying patterns. They may be a natural transient erotic phase of a positive transference thereby facilitating a deepening of the relationship with a subsequent understanding and integration of such feelings. Less uniformly facilitating are those transference manifestations of pathological self-esteem regulation that occur through sexual idealization. The non-facilitating intractable forms may represent a destructive form of sadomasochistic reenactment or an eroticized defensive reaction against primitive hate. In the latter an interminable therapeutic stalemate or a premature disruption may bring about termination.

The overt manifestations of the erotized transference vary not only as a function of the patient's unconscious conflicts and personality structure but also its form is influenced by the sex of the patient as well as that of the analyst.

Analytic problems may occur if the erotic transference develops fully and is subsequently expressed extra-analytically, or if the "acting in" is resistant to interpretation. When such transferences remain undeveloped and are neither fully experienced or expressed during the analysis, a stagnant, incomplete analysis ensues.

Intense transferences should not be discouraged in themselves. It is only through such re-experiences that meaningful insight can be gained and worked through in the light of a new reality-the present not the past. The "intractable" erotic transferences remain so because of the reality distortion and difficulty with drive sublimation noted in these cases. There may be a general ineffectiveness of interpretation alone in the attempt to understand and modify this resistance which manifests itself as a pressured infantile love demand from the patient.

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Enactments: An Evolving Dyadic Concept of Acting Out.

Am. J. Psychotherapy, 50, No. 2, 194-207, 1996.

Acting out seeks to communicate unconscious urges and important childhood experiences, yet can present as a resistance to insight. Mutual and interacting regressive transferences stimulate acting-out behaviors that have led to the concepts of actualization and enactment. An enactment is an unconscious but interpersonal communication, in which gestures and body language play a unique role. Initially an enactment may include a component of the therapist's reciprocal behavior as a precursor to fuller dynamic understanding and eventual definitive interpretation.

Summary

Unspoken actions between the therapist and the patient have major and often unconscious influences on the psychotherapeutic situation. Mutual transferences can bring about acting-out behaviors that portray transference wishes and defenses within both parties. Such actions tend to replace or overshadow verbalizing intrapsychic strife and in that sense can function as formidable resistance to therapeutic introspection. They also may represent behavioral attempts to communicate significant earlier experiences. Reflection on this dyadic interplay has led to contemporary treatment concepts.

Enactment, actualization, and treatment misalliances are behavioral manifestations of urges, conflicts, and identifications and they appear most frequently during regressive periods in psychotherapy. Initially an enactment may include a component of the therapist's reciprocal behavior as a necessary feature of the process, prior to a fuller dynamic understanding and eventual definitive interpretation. Collusion by the therapist, through mutual and continuing acting out or through attempts to re-parent will encourage anti-therapeutic misalliances that can lead to continuing symptomatic behaviors and boundary violations.

Continuing self-inquiry is essential to facilitate therapeutic change and we need to be aware that the principal analyzing device available to bring about positive change in our patients, is to be found within ourselves.

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Contemporary Considerations Influencing Psychoanalytic Interventions.

Can. J. Psychoanalysis, 1; No. 1, 7-25, May 1993.

Summary

Contemporary analytic interventions require consideration be given to the subjective realities of both the analyst and the analysand within that analytic situation. Recent controversy with regard to the management and theoretical understanding of the analyst-analysand intersubjectivity in analytic practice is outlined. The importance of narcissistic transferences and the vicissitudes of their resultant countertransference is a major consideration in understanding the dynamic analytic situation. Interpretations reflecting these issues need not be dependent upon the acceptance of a self-psychological viewpoint. Pre-interpretive interventions, focusing on the analysand's immediate reality and affect, are essential precursors to effective genetic and transference interpretation. Exploration of affective mutual experiences within an analysis facilitates the developing therapeutic alliance and brings about a more genuine and cohesive identity. It is stressed that effective interventions lie on an expressive-supportive continuum. Interventions that utilize and dynamically explore intersubjective processes and enactments tend to encourage conscious reconstruction rather than repetitious living out of regressive transferences.

Concluding Remarks

More recently psychoanalytic technique has emphasized the need to identify and interpret present-day reenactments as well as uncovering and reconstructing the past within the analytic dyadic situation. The importance of the analyst as an actual object for the patent as well as the analyst's responsivity or lack of same within the intersubjective space, has been stressed. The primary role of affects, as well as words, is now accepted as an essential vehicle for therapeutic interventions, hopefully bringing about expanded conscious fantasy and revised subjective experiences. That there has been a gradual but significant clinical shift in mainstream psychoanalytic interventions from primarily drive oriented transference interpretations to include object related and intersubjective interventions without necessarily accepting an independent theory of narcissistic self development.

Psychoanalytic interventions lie on a continuum from expressive interpretations of the unconscious to supportive conscious affirmations and educational commentary. The relevance and significance of specific interpretations and reconstructions need to be confirmed by both the patient's and therapist's subjective analytic experience as well as cognitive insight. Identification and exploration of shared analytic phenomena may elicit and facilitate conscious reconstructions rather than repetitious living out of regressive transferences.

The expanded role of subjectivism, not only in the patient but within the analyst and the analysis of this interaction continues to be emphasized. The analyst as an external figure and a stimulus to internal objects as well as being a function for the development of the patient's self, all play an important role in how the patient deals with urges, prohibitions, and fantasy life. These contemporary considerations should not be seen as an end in themselves but as a feature of an essential strategy for facilitating further self inquiry into the analysand's internal world.

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Premature Termination Issues involving Psychoanalytic Control Cases.

Can. J. Psychoanalysis, 3; No. 1, 17-41, May 1995.

One hundred and nineteen (119) control case analysands who had been assessed by both candidate and supervisor analysts as being suitable, began analyses. All analytic patients studied were consecutive control cases taking place over a six year period beginning from 1985 through 1991. The only significant difference in assessment protocol between the two psychoanalytic institutes was that most of the patients accepted in Montreal had been seen in consultation by the candidate analysts' supervisors while in Toronto the supervisors usually assessed suitability from the candidates case presentations alone.

Summary

A psychoanalytic assessment and outcome study was undertaken in an effort to determine the frequency and characteristics of control analysands who dropout, as well as to identify some of the therapist and supervision factors which may be associated with premature termination.

Premature termination during the first year of analysis, takes place in about one quarter of all accepted and commenced psychoanalytic control cases. One half of all those terminating prematurely, dropout within the first three months. It is suggested that there may be important similarities within this earliest dropout group. Frequently they exhibited unstable and regressive transferences and/or problematic motivation from the outset of the analysis.

There were significantly more female than male analysands in therapy while there were equal numbers of male and female candidate-therapists. There were no significant differences in the subsequent dropout rates associated with the patient/analyst gender match, nor the psychoanalytic training institute involved.

The most inexperienced candidates have the highest dropout rate, with more than one third of their first cases leaving prematurely and often precipitously. During the initial assessment, supervisees appear to consistently underestimate the degree of their analysands' psychopathology.

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What Is Effective Self-Analysis - Is It Necessary Or Even Possible?

Can. J. Psychoanal., Vol.4: No. 2: 291-307, 1996.

Self Inquiry is a form of wondering, a journey to the edge of awareness. This study of the self as the subject, can lead to an expanded understanding of our self schemata, past and present. Self analysis is the last stage in this series of mental processes which begin with curiosity, go on to self observation then introspection and conclude hopefully with an integration of the factors on which we have been reflecting. The first steps of self inquiry are routinely practised by philosophers, writers, jazz musicians, spiritualists and others who make use of observation, intuition, reason and faith. Enlightenment through contemplation and logical deduction is an aspect of all great religions and philosophies as well as a feature of most scholarly pursuits. Yet perhaps it is only with the addition of psychoanalytic understanding that one is able to more fully access the unconscious with its contradictory repressed and metaphorical complexes. Free association was the tool Freud used to gain entry to this inner world of unconscious motivation. Originally Freud's self analysis involved the investigation of his dreams, affective memory traces, symptom symbolisms and parapraxes, which he noted were frequently stimulated by his work with patients.

Self analysis, as I will explore in this paper, most simply put, is the attempt to explore, modify and understand why we are as we are. It is primarily a solitary analytic activity, undertaken after completing a psychoanalysis. Used in this frame of reference others have called it perhaps more accurately, self re-analysis or auto-analysis. However I do not consider it to be an alternative to replace formal dyadic psychoanalysis.

Summary

Self analysis is the last stage of a process of self inquiry which begins with curiosity, progresses through self observation then introspection and concludes with an integration of the factors on which we have been reflecting. Through the practice of free association and contemplation concerning our dreams, fantasies, memories, symptoms and work related countertransferences and enactments, we can gain insight into our repetitive conflicts, deficiencies and strengths. Self analysis may be an expression of the continuing search to heal ourselves and a reparative attempt to deal with disillusionment. It is also suggested that for self analysis to be effective, an effort must be made to actively apply that which we have become aware of, through the processes of self inquiry.

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Regressive Transferences - a Manifestation of Primitive Personality Organization.

Am. J. Psychotherapy, 44; No.1, 50-60. Jan., 1990.

Abstract

Patients with primitive personalities form regressive transferences that tend to be unstable, repetitive, preverbal and ungratifying. Primitive libidinal, automatism and somatization transferences are examples of such regressive transferences. They present as primal reenactments that can become formidable resistances to the development of a therapeutic alliance or meaningful interpretation.

Summary

Regressive transferences are but one manifestation of dynamic infantile and frequently unconscious fantasies seen in patients with a primitive personality organization. Such transference relationships may vary from an apparent profound unrelatedness to intense symbiotic dependencies. These transferences are primarily preoedipal and may include grandiose, persecuting, somatizing and dehumanized object experiences as well as narcissistic idealizing and denigrating selfobject formations.

Three types of regressive transferences in patients with primitive personalities are described. Primitive libidinal, Automatism and Somatization transference, all three demonstrate symbolically meaningful but primarily unconscious primitive transference reenactments.

Regressive transferences not only represent impulses seeking gratification but are also restitutive attempts for earlier losses and lack of self cohesion. Patients with a primitive personality organization often suffer early deprivations which bring about the formation of unstable internal representations. This makes acceptance of ambivalence and mourning difficult due to fear of ego dissolution from the aggression towards the self and others. Identification and exploration of shared intersubjective phenomena may facilitate conscious reconstruction and eventual interpretation of these regressive transferences.

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Assessment Factors Associated with Premature Psychotherapy Termination.

Am. J. Psychotherapy, 46; No. 2, 250-261, April 1992.

Premature psychotherapy termination is associated with certain specific ego deficits and environmental circumstances that can be evaluated at the time of initial assessment. Introspection, Frustration Tolerance, Motivation, positive Countertransference and Life Circumstance factors most highly discriminate between the terminators and the continuing therapy group.

Results

Of the 20 cases (PT) who prematurely terminated out of the 85 patients assessed (50 psychotherapy / 35 psychoanalysis), 12 had been in psychotherapy and 8 were psychoanalytic dropouts, that is similar to the overall frequency of these two undertaken treatment modalities. The type of psychotherapy did not indicate differences in the eventual termination outcome, with 1/4 terminating early for both psychotherapy and psychoanalysis. Of the 20 cases who dropped out during therapy, 10 (50%) did so within the first month.

There was a total of 22 female and 18 male patients rated by 21 female and 19 male therapists who completed the assessment questionnaire ratings and undertook supervised psychotherapy or psychoanalysis of the patients. Neither the age nor gender of the patient or therapist was significantly related to premature termination. There was a trend towards lower impairment ratings for the female patients and higher dropout rates among the female patient/female therapist combinations which represented a total of 40% (8/20) of all the therapy combinations which eventually discontinued. The three other patient/therapist gender combinations were similar (4/20) concerning patient attrition rates. There was trend towards higher dropout rates in those psychoanalytic control patients under 25 years. There was no one diagnostic entity that differentiated between the two groups although an axis 2 diagnosis with either narcissistic or borderline traits was the most frequent diagnosis in the dropout group.

Summary

Characteristics of patients accepted for both intensive psychotherapy and psychoanalysis were rated during their initial assessments. Twenty cases that terminated prematurely (most frequently within the first month) were compared with twenty cases that continued in therapy. While neither specific diagnosis, type of insight therapy, nor gender of the patient or therapist was a reliable predictor of premature termination, it was found that psychodynamic and environmental assessment factors significantly differed between these two groups.

In those patients who eventually dropped out, specific ego deficits primarily introspection, frustration tolerance, impulse control and motivation were rated as significantly more impaired. The therapists' negative feelings towards their prospective patients and the patients' hostility towards past caretakers and present life circumstances were also associated with premature termination.

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Supervising the Supervisors - the Evolution of a Psychotherapy Supervisors' Group.

Am. J. Psychotherapy, 45; No.1, 34-42. Jan., 1991.

After several years, a successful psychotherapy supervision group format evolved with the primary emphasis being placed on free group discussion following a proposed supervision topic. The more inexperienced psychotherapy supervisors initially wanted a structured didactic approach, while senior members favoured subjective exploration of therapeutic and supervisory relationship factors. It is felt that these two supervisory group needs can be academically complimentary.

Summary

Three distinct psychotherapy supervision group formats developed over a fourteen year period. The most consistently successful format was having a proposed psychotherapy supervision topic but with the primary emphasis being placed on free group discussion. The more inexperienced psychotherapy supervisors initially seem to want a more structured didactic approach e.g., teaching seminars, while senior members favor a spontaneous and personal exploration of specific therapeutic and supervisory relationships.

Psychotherapy supervisors in a group situation can explore and promote a deeper understanding of the supervisor-therapist relationship. They can function as a didactic study group as well as it being a useful interpersonal learning experience without the group having a therapeutic format. Group member interactions highlight the importance of the intersubjective nature of transferences and alliances, beginning with how the group leader responds to the other supervisors which then can be a model for the subsequent supervisor/supervisee processes. The leader of such a supervisors group can be more helpful if he will see himself as a facilitator of essentially peer group observations rather than a transference interpreter or group teacher.

Psychotherapy training programs should consider the introduction of a psychotherapy supervisors' group to improve the teaching and learning of psychotherapy skills. The efficacy of such supervisors' groups cannot be easily measured although it is suggested that patient outcome and supervisee satisfaction is significantly related to the quality of psychotherapy supervision provided.

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Influence of Dyadic Factors on Enactments

Can. J. Psychoanalysis, 1; No. 2, 61-83, Nov., 1993.

Sometimes during an analysis there are puzzling non verbal interactions that are vitally meaningful and require understanding and interpretation. Current psychoanalysis gives much greater importance to the role and interplay of such dyadic factors within the analytic relationship than the classical transference / countertransference paradigm alone would suggest. The development of an analytic relationship is determined by the ongoing mutual transferences and their interaction with the working, realistic and primary (narcissistic) relationships (De Jonghe & Rijnierje, 1991). Although transference has been studied extensively in psychoanalysis it is ubiquitous in everyday-life and develops in all social situations where another person is important to one's life. As such, it is a major feature of all human relationships. The trend in contemporary theorizing is towards a multimodel approach stressing the patient's subjective perspective. While individual schools of psychoanalytic thought continue to see themselves as unique in their theoretical understandings, more analysts seem to be using several models concurrently usually reflecting a two person relational psychology rather than a single metamodel

SUMMARY

The unspoken dyadic interaction between the analyst and the analysand has a major (often unconscious) influence on the psychoanalytic situation and its process. Mutual and interacting transferences can bring about behaviours which portray transference resistances within both parties. Consideration of the interplay between regressive transference and countertransference has led to the concepts of actualization and enactment. This involves the stimulation by one party of responses in the other which the first person then responds to or experiences as an actualization of a transference perception. Enactment is an unconscious but interpersonal communication, in which gestures and body language play an important role in its expression. It represents an attempt to communicate early experiences that, hopefully, inspire the analyst to create a holding situation. Initially an enactment may include a component of the analyst's reciprocal behavior as a necessary feature of the process prior to fuller analytic understanding and eventual definitive interpretation. An ongoing collusion by the analyst, through mutual and continuing acting out or through attempts to re-parent, will however encourage anti-analytical misalliances and continued symptomatic behaviour rather than the resolution of these actualizing transferences.

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The Nature and Function of Unconsious Communication in the Analytic Process

Can. Psychoanal. Soc., June 6, 1997.

Utilising the subjective experience of the transitional field that unfolds during an analysis involves the analyst receiving, and processing unconscious communications. This mutual interplay should focus predominantly on the patient as the beneficiary of insight, albeit such analytic investigations have dyadic components.

Some unconscious communications will lend themselves more significantly to transference interpretation while at other times interventions highlighting the countertransference or intersubjective features will be more immediately and empathically productive.

The analyst, to be effective, is required to surrender to a receptivity involving unconscious elements within the analysis; and secondarily to create verbal symbols for what had previously been intolerable and unspeakable aspects of the analysand's intrapsychic world.

Not all analytic nor therapeutic change is due to interpretation and insight. As analysts we should try to be open-minded about how positive change can come about within our patients and even in ourselves, as a consequence of vital but frequently unconscious communications.

SUMMARY

Unspoken actions as well as verbal communication between the therapist and the patient have major and often unconscious influences on the psychoanalytic situation. The dynamic unconscious has a mutual but frequently asymmetrical influence within this analytic relationship.

Some unconscious communications will lend themselves to transference interpretation while at other times interventions highlighting the countertransference or intersubjective features will be more constructive.

This unconscious influence can be either therapeutic or psychotoxic depending on the analyst's understanding of and involvement in such communications. The analytic goal is to focus on is the patient's psychic reality and self-understanding. At times this may also include putting forward the analysts' subjectivity.

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Unconscious Communication and Its Relational Manifestations in the Analytic Process

(ABSTRACT) (1998) Can. J. Psychoanal.Vol.6, No.2; 207-232.

The presence of a presumed intersubjective field or an "analytical third" raises questions about its theoretical nature as well as the possibility of a therapeutic function involving an unconscious link between the analyst and analysand.

It is primarily the clinical aspects of the theme of unconscious communication that I want to depict and explore. I begin by proposing a number questions about the nature of the unconscious and its manifestations:

  1. Do the opening quotations presuppose the existence of a "dyadic unconscious," that is a singular shared structure that can arise or is jointly created and maintained by the dyadic interplay within that relationship?
  2. What about the thorny problem of a purposeful connection between unconscious processes that bypass and are independent of both observational psyches?
  3. In metapsychological terms, what is this "transitional field"?
  4. Is there indirect transmission of unconscious contents into that transitional field, or are they in an uncanny way deposited from one unconscious to another?
Communication is an act of imparting news or information, and it also can mean a shared connection between people and places. So called one-person psychology gives consideration to the first part of this definition, that is, with the focus on a distinct giver and a distinct receiver of ideas. The latter feature stresses the shared and potential mutual influence between persons and is often referred to as the intersubjective approach. The evolution of the scope of psychoanalysis now includes not only the inevitable transferences and countertransferences but also the unconscious communication between both parties. Originally the "scandal of the unconscious" concerned itself with the problematic areas of unconscious communication, primarily the hindrances and transgressions brought about by the "co-transferences," and only later have psychoanalysts focused on its facilitating aspects.

Conclusion

Contemporary analytic technique requires consideration be given to the subjective realities of both the analyst and the analysand within that analytic situation. Interventions that reflect these issues need not be dependent upon acceptance of a single or specific theoretical viewpoint.

Utilizing the subjective experience of the transitional field that unfolds during an analysis involves the analyst's receiving and processing unconscious communications. This mutual interplay should focus predominantly on the patient as the beneficiary of insight, although such analytic investigations have dyadic components.

Some unconscious communications will lend themselves more significantly to transference interpretation, while at other times interventions that highlight the countertransference or intersubjective features will be more immediately and empathically productive. In order to be effective, the analyst is required to surrender to a receptivity that involves unconscious elements within the analysis, and secondarily to create verbal symbols for what had previously been intolerable and unspeakable aspects of the analysand's intrapsychic world.

Therapeutic and analytical change is not always the result of insight brought about through interpretation. As analysts we should try to be open-minded about how positive change can come about within our patients and even in ourselves, as a consequence of vital communications of which we are unaware.

SUMMARY

Contemporary thought about unconscious communication in the analytic situation focuses more on its dyadic manifestations than on the analysand's topographical "mental apparatus."

Unspoken actions as well as verbal communication between the analyst and the patient have major and unconscious influences on the developing psychoanalytic situation. The dynamic unconscious has a mutual but frequently asymmetrical influence within this analytic relationship.

Some unconscious communications will lend themselves to transference interpretation while at other times interventions that highlight the countertransference or intersubjective features will be more constructive.

These unconscious influences can be either therapeutic or psychotoxic, depending on the analyst's understanding of and involvement in such communications. The analytic goal is to focus on the patient's psychic realignments, as often portrayed through unconscious relational manifestations, thereby advancing self-understanding. At times this may also include putting forward the analyst's subjectivity.

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Charismatic Leadership, Boundary Issues, and Collusion

Dorian, B., Dunbar, C., Frayn, D.H., Garfinkel, P. Am. J. Psychother., 54: 216-225, 2000

Summary

The authors suggest that a charismatic leadership style has an impact on the maintenance of boundaries and standards of practice within a department of psychiatry. A role (unconscious) is thrust upon and often assumed by the charismatic leader that may initially enhance the group's success but the group in collusion with this entitlement can lead to unacceptable behaviour and eventually the leader's downfall. The authors also underline the need for all members of a self-regulated professional group to assume responsibility for the maintenance of standards within the group.

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Internet Discussion Review: "Sketch for a Metapsychology of Affect".

Original paper by Irene Matthis (Int. J. Psychoanal. 81: 841-848, 2000) and discussion edited by Douglas H. Frayn (IJPA Internet Guest Editor)

Abstract

This paper and its subsequent IPA Internet discussions during May and June 2000 gave psychoanalysts an opportunity to revisit controversies concerning earlier metapsychological formulations of affect and its unconscious processes. In addition Dr. Matthis proposes contemporary psychobiological findings as being a useful extension to our understanding of affect and its associations with the unconscious. This is primarily a theoretical paper with neurophysiological research quoted rather than clinical situations with psychoanalytic observations put forward. Problems such as how consciousness interplays with a meaningful "unconscious" and in what form affects are situated in the unconscious through their associated mental or somatic representations are discussed. For Matthis, affect is a psychological concept lying on the frontier between the mental and the somatic. She finds support in Freud's second hypothesis in 'An Outline of Psychoanalysis', where he writes that psychology should look to the somatic processes to see the true essence of what is psychical. From this baseline she attempts to define and differentiate the concepts of feeling, emotion and affect.

Most relevant to the discussion is Bion's formulation that thinking commences with the emotional experience of and in bodily events. Affect then may be processed through symbol formation and becomes available through dreaming and then for transformation into thought. Clinically we see it when people first experience a somatic state and begin to apprehend a conscious emotional experience. Emotional experiences that are not worked upon by alpha function then are evacuated into the body. This is Bion's theory of the psychosomatic as well as primary role of affect transformation either into symbolic thought or into "unthought" somatic manifestations. Early traumatic and pleasurable psychobiological events leave their mark on patterns of affectivity and its subsequent behavioural response. We should focus on the child's earliest affective states, that is his subjective states. These patterns tend to be endlessly repeated or "lived-out" by analysands without awareness of their historical emotional background. The intersubjective analytic situation highlights that the analysand compels the analyst to experience the patient's inner object world through shared fantasy that previously had only remained within him. This causes the analyst to relive the patient's early (affective) life and to exist with some feeling inside his internal world for which then words for these unassimilated feelings may then be made accessible for the patient to consciously recognize and re-experience in a novel light. The primary object of psychoanalysis as originally envisaged, was not healing, but rather learning reflectively and experientially about truth and knowledge.

SUMMARY

This discussion paper revisits controversies concerning the metapsychological formulations of affect and its unconscious processes. Dr. Matthis proposes contemporary psychobiological findings as being a useful extension to our understanding of affect and its associations with the unconscious primarily through its somatic manifestations. She writes that psychology should look to the somatic processes to see the true essence of what is psychical. From this baseline she attempts to define and differentiate the concepts of feeling, emotion and affect.

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Discussion of Fairbairn and Chaos Theory: A New Paradigm for Psychoanalysis.

Can J. Psychoanal. Vol 8, No 4: 197-206, 2000. by D.H. Frayn

ABSTRACT

Mainstream psychoanalysis owes Fairbairn and his ideas a great deal more than just lauding the basic tenet of the ego's object seeking being of greater importance than instinctual gratification. Klein changed the name from the Paranoid to the Schizoid-Paranoid position after she reflected on the universal infantile ego splitting as described by Fairbairn. Winnicott acknowledged borrowing the term "transitional" to describe the infant's first "not-me" possessions and the concept that - all have a schizoid aspect to our personality, where the ego's splitting manifests itself into the dilemma of fleeing from/hanging onto significant relationships. Relational psychoanalysis with its emphasis on the interaction between the patient and the analyst as the crucial agent of therapeutic change is also indebted to Fairbairn. Fairbairn anticipated much of what Kohut later wrote. Many of Fairbairn's techniques dealing with schizoid patients are now accepted such as avoiding using the couch and the analyst being willing to function as an auxiliary object-ego; that is a reorganising external object during times of regression when the internal objects are in chaotic disarray.

Fairbairn felt that the most significant internalised object was the persecutory bad mother that required neutralisation by the therapist. Thus the analyst was to present himself as a powerful good object to actually provide that missing security. A dynamic analytic relational approach differs from these interpersonal models because experience has shown us that manipulation of these external objects does not necessarily reduce inner conflicts. It is my position that an "object relational point of view" or even a recent clinical extension of this theory - the "intersubjective approach", should not be viewed as a separate school of psychoanalysis but as an important feature of all analytic interventions regardless of the theoretical orientation of the analyst. The recent emphasis on the patient's internal object world and subjectivity is seen by some analysts as signifying a novel and major psychoanalytic perspective shift, while others feel that the theoretical change is primarily semantic rather than substantive.

"Chaos (theory) has escaped its original bounds and in so doing has to some extent been devalued. They take some system with no obvious pattern, declare it to be an example of chaos, and suddenly it is living on the intellectual frontier rather than being boring old statistics. Chaos has become a metaphor but too often the wrong metaphor. ... Chaos is used as an excuse for the absence of order or control, rather than as a technique for establishing the existence of hidden order or method for controlling a system that at first sight seems uncontrollable." It is not surprising that abuses emerge such as the naive application of chaos theory to psychoanalysis, whenever deep intellectual concepts become fashionable rather than scientific.

SUMMARY

Mainstream psychoanalysis owes Fairbairn and his ideas more than just lauding the basic tenet of the ego's object seeking being of greater importance than instinctual gratification. Fairbairn felt that the most significant internalised object was the persecutory bad mother that required neutralisation by the therapist. Thus the analyst was to present himself as a powerful good object to actually provide that missing security.

Whenever intellectual concepts become fashionable rather than scientific, abuses emerge such as the naive application of chaos theory to psychoanalysis.

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