Marco Conci interviews Stefano Bolognini

Abstract

This paper suggests that the understanding of intersubjectivity, which refers to “the dynamic interplay between the analyst's and the patient's subjective experiences in the clinical situation”, is crucial for psychoanalytic work. The analyst's inner experiences, from the first moment that he or she thinks about or meets the patient, belong to an intersubjective situation. Not only are these experiences a valuable channel through which the inner experiences of the patient can be understood, but—as Theodore Jacobs puts it—they are often complementary to that which comes from the patient. The author tries to illustrate the above through the study of the analytic process in the psychoanalytic therapy of a severely disturbed patient. This therapy from its very early phase led to the reawakening of some of the analyst's old conflicts. The patient's difficulties in tolerating the limits of the analytic setting and using free association are discussed, as are his enactments. The analyst's close observation of the interaction between her and the patient, the permanent engagement with her countertransference, and the use of her inner experiences with the patient helped her to contain the enactments, defined the nature of her interventions, and contributed to the analytic process.     

Clinical Writing About Clients: Seeking Consent and Negotiating the Impact on Clients and Their Treatments

The author discusses her experiences seeking consent from 16 clients to use clinical material for publication. Sharing case examples from her practice, she elucidates her process with clients and focuses on the beneficial and detrimental effects on the therapeutic relationship. Seeking consent raises issues of confidentiality and stimulates wide‐ranging, layered, and linked emotions and meanings for clients, including feelings of closeness, envy, and shame. If the counselor actively employs this process as a therapeutic tool with openness to unexpected meanings, it may advance the therapeutic conversation and developmental possibilities. When there is a negative effect on the client or the process, counselor's shame and guilt may be stimulated and consultation is recommended.     

Coming Out in Voices

This paper articulates the personal experiences of a woman with a physical disability who enters therapy to explore issues involving lesbian identity, health and illness, disability oppression and pride, and relationships. Written in the first person, the article uses anecdotes, poetry, and journal entries to chart the author's process of self-discovery. As a woman, a lesbian, and a person with a disability, the author frequently finds herself at odds with the culture around her. This creates conflicts between the author's real self, and the self she must present to others. She discusses how she had learned to "silence the voices" which were not useful in challenging the stereotypes, making others comfortable, or communicating with assistants. The author describes how therapy offered her the opportunity to unlearn the silence, value all of her voices, listen to herself, resolve her internal dilemmas, and develop a deeper sense of self.     

A case history: from traumatic repetition towards psychic representability

This paper is devoted principally to a case history concerning an analytic process extending over a period of almost ten years. The patient is B, who consulted the author after a traumatic episode. Although that was her reason for commencing treatment, a history of previous traumatogenic situations, including a rape during her adolescence, subsequently came to light. The author describes three stages of the treatment, reflected in three different settings in accordance with the work done by both patient and analyst in enabling B to own and work through her infantile and adult traumatic experiences. The process of transformation of traumatic traces lacking psychic representation, which was undertaken by both members of the analytic couple from the beginning of the treatment, was eventually approached in a particular way on the basis of their respective creative capacities, which facilitated the patient's psychic progress towards representability and the possibility of working through the experiences of the past. Much of the challenge of this case involved the analyst's capacity to maintain and at the same time consolidate her analytic posture within her internal setting, while doing her best to overcome any possible misfit (Balint, 1968) between her own technique and the specific complexities of the individual patient. The account illustrates the alternation of phases, at the beginning of the analysis, of remembering and interpretation on the one hand and of the representational void and construction on the other. In the case history proper and in her detailed summing up, the author refers to the place of the analyst during the analytic process, the involvement of her psychic functioning, and the importance of her capacity to work on and make use of her countertransference and self-analytic introspection, with a view to neutralizing any influence that aspects of her 'real person' might have had on the analytic field and on the complex processes taking place within it.     

Change,Vulnerability, Fear,and Taking Risks–An Interview with Virginia Satir

SUMMARY

The author addresses the mythic characters of Ulysses and Penelope as archetypes for herself. She reviews divergent attitudes, beliefs and aspirations of her life by detailing an internal conflict between her identification with Ulysses1 adventuresomeness and her reluctant realization that Penelope can also represent her, however much she rejected her for seeming dull and repetitve

In this process the author notes how she constricted her own creativity when she took on uncritically the patriarchal beliefs about the roles of wives and mothers. Nevertheless she wonders whether present-day women's liberation from archaic notions about women inadvertently sacrifices the optimal development of children because of the rigid demands of the work-place.

Finally she experiences the symbolic reunion of Penelope's and Ulysses' different images within herself, and considers how what each represents can have renewed meaning for her as she moves towards the end of her life.     

Cultural function and psychological transformation in psychoanalysis and psychoanalytic psychotherapy

Cultural experience of silence and individual vicissitudes between talking and being silent infl uence the way individuals form an alliance and pursue the analytic process. This is of relevance both for the patient and for the psychoanalyst/therapist. The author describes a patient, whose silent phase occurred in the fi fth and sixth year of intensive psychoanalytic psychotherapy. She suggests that a) the silence functioned as a protection of a space for the core self and promoted inner transformation and psychologicaldevelopment;b)thesilenceinvolvedatransference-countertransference matrix with projective identifi cations of the patient's internalized mother- and father-related objects that caused a tenuous balance between maintaining and erasing the relationship between the patient and the author; c) the silence phase was highly infl uenced by the author's own cultural background and what she brought into the relationship of tolerance of being silent in the presence of another, and understanding of the many complex functions of silence. During the silent phase the patient moved from simply describing and naming her affects and inner experiences or expressing them as somatic processes, to being able to internally access and verbally convey her own affects and experiences in the therapeutic alliance. This process involved both affect desomatization, affect differentiation, and affect verbalization.     

Transformative Aspects of Our Own Analyses and Their Resonance in Our Work With Our Patients

As psychoanalysts, our own relational stories, our “wounds that must serve as tools” (Harris, 2009 Harris, A. April 2009. “Keynote address at the meeting of the Division of Psychoanalysis, American Psychological Association, Toronto, Canada.”. In You must remember this April,  [Google Scholar]), represent both our greatest liabilities and potential for change, at times facilitating and at times impeding our capacity to engage deeply in the analytic process. Transformative aspects of our personal analysis dwell, often unconsciously or preconsciously, in the analyst, generating unanticipated opportunities in our work with our patients. In this paper, the author describes how a profound piece of work in her own analysis around healing in her relationship with her young son resonated in her work with a long-term patient, enlivening and deepening the treatment. The author explores how she drew on the interpenetrating experiences of analyst, patient, mother, and child, helping her to deconstruct a complex enactment with her patient, and opening up potential space. In the process, her patient discovered new places within herself, which enabled her to reach out to her vulnerable teenage son in new and reparative ways.     

From Maternal Impressions to Eugenics: Pregnancy and Inheritance in the Nineteenth-Century U.S.

This essay examines the theory of maternal impressions, the belief that a woman’s experiences or emotions during pregnancy could explain congenital disability or emotional/ behavior differences in her child and asks why this theory circulated as an explanation for disability seen at birth by both medical doctors and in literature for far longer than it did across the Atlantic. By presenting examples from nineteenth-century medical literature, popular fiction, maternal handbooks, and two canonical works of literature, Nathaniel Hawthorne’s The Scarlet Letter and Harriet Jacobs’ Incidents in the Life of a Slave, I argue that maternal impressions worked to maintain anxiety for women, and particular white women, to ensure they felt responsible if anything was “wrong” with their child. Ultimately, I show how maternal impressions was both an ableist and racialized understanding of inheritance that wouldn’t be discarded until the emergence of eugenics in the early twentieth century.

     

Reclaiming Culture: Reculturation of Transracial and International Adoptees

The cultural experiences of transracial and international adoptees (TRIAs) are uniquely affected by their adoption across cultures and racial/ethnic groups. Upon adoption, TRIAs typically identify quickly with their adoptive parents’ White culture but may eventually seek to reclaim their birth culture. Current terminology used to describe cultural identifications and changes (e.g., acculturation, enculturation) does not adequately depict the reclamation of birth culture by TRIAs. The authors describe a new term for this process called reculturation.     

‘Sleeping beauties’: succession problems of adolescence

The author explores the succession problems of adolescence. She uses the Brothers Grimm’s fairy tale Sleeping Beauty to consider various characters and narratives possible in the analytic field during the succession process. Use of the characters in a fairy tale allows an analyst to play with the different roles the patient unconsciously assigns her. The author conceives of the avoidance of adolescent turbulence as a common reaction to adolescence, but one that can also become entrenched, and result in a restriction of emotional growth. The paper explores the psychic isolation of adolescence and the splitting required to manage the conflicting desires of the phase. The persistent absence of passion, including in the analytic process, constitutes a psychic retreat from developmental turbulence. The analyst of such an adolescent may need to allow them to be ‘somnolent’ for some time, but may eventually need to wake them (metaphorically) or even pierce the somnolent, avoidant state. The author uses clinical vignettes of late adolescents to demonstrate such transitions, exploring her countertransference experience as well as the reaction of adults to the succession process of adolescence.     

Meeting a New Me: An Autoethnographic Journey into Kenya and Back

In this article the first author (MG) examines her experiences, reflections, and questions after traveling to Kenya and then attempting to integrate those experiences into her Western life. Using an autoethnographic format, different implications for the author are explored as she becomes more culturally aware both of other ways of being as well as of her own identity. MG publically shared her experiences on three different occasions, and then used a reflective stance to consider the implications of the questions posed for her personally, for the therapy field, and for the meaning of maintaining multicultural competencies.     

When the Tree Falls and No One Hears It: On Being Dropped and Learning to Hold

This case study focuses on a student therapist’s reflections upon a premature termination that occurred in her work with an adolescent male patient. The therapeutic process is traced back to the beginning of treatment, and the article delineates the extent in which the patient’s early interpersonal experiences influenced the development of the therapeutic alliance. The author addresses several themes that evolved throughout the treatment, including the patient’s experience of unpredictability and instability and his inconsistent understanding of time, and the ways in which these experiences ultimately influenced the treatment’s ending. The article describes the therapist’s development as a clinician over the course of the treatment, focusing on the various experiences that helped her consolidate a dynamic understanding of the holding environment.     

(My) spirituality in medical education

During these times of the situated, contingent text, it is not unusual for an author to disclose her biases and other sources of potential partiality as a researcher or theorist. That is, an author often discloses her race, class origins, or sexual orientation at the onset, announcing particularities that enable readers to adjust their reading to the subjectivities inherent to knowledge production. One glaring omission to these announcements, especially in medicine, has to do with the spiritual domain. This essay, written as a personal narrative, provides one example of how one's spirituality is connected to what and how one chooses to teach, even in the medical academy. Acknowledging those beliefs and considering how our spirituality (along with our other subjectivities that are known to us) may influence our work is an important process in developing a more reflective practice.     

When the therapist says goodbye

Therapist-initiated termination poses several unique problems for both the group and the therapist. This paper describes the termination process from the point of view of this therapist's experience in planning the termination of her group therapy practice. The reactions of other analysts to her decision to retire and the group processes and individual patient's reactions in this long-term psychoanalytic therapy group are described in detail. The author follows the group process and her own inner processes in the final six months of the group. The importance of the working through of the termination phase of therapy is supported by the experiences that were shared by the group and the therapist.     

Negative hallucinations,dreams and hallucinations: The framing structure and its representation in the analytic setting

This paper explores the meaning of a patient's hallucinatory experiences in the course of a five times a week analysis. I will locate my understanding within the context of André Green's ideas on the role of the framing structure and the negative hallucination in the structuring of the mind. The understanding of the transference and countertransference was crucial in the creation of meaning and enabling the transformations that took place in the analytic process. Through a detailed analysis of a clinical example the author examines Bion's distinction between hysterical hallucinations and psychotic hallucinations and formulates her own hypothesis about the distinctions between the two. The paper suggests that whilst psychotic hallucinations express a conflict between life and death, in the hysterical hallucination it is between love and hate. The paper also contains some reflections on the dramatic nature of the analytic encounter.     

Religious Beliefs or Physicians’ Behavior: What Makes a Patient More Prone to Accept a Physician to Address His/Her Spiritual Issues?

The present study aims to understand the relation between religious beliefs, physicians’ behavior and patients’ opinions regarding “Spirituality, religiosity and health (S/R)” issues, and what makes a patient more prone to accept a physician to address his/her spiritual issues. A cross-sectional study was carried out in outpatients from a tertiary hospital, and a path analysis was used to examine the direct and indirect relationships between the variables. For the final analysis, 300 outpatients were evaluated. Most patients would like their doctors to address S/R issues but did not feel comfortable to ask them. In contrast, they reported most doctors have never addressed S/R issues, and they believe doctors are not prepared to address these issues. The path analysis revealed that patients’ previous experiences with their doctors may be as important as their religious/spiritual beliefs in proneness to accept a physician to address his/her spiritual issues.     

Mad Scientist: The Unique Case of a Published Delusion

In 1951, entomologist Jay Traver published in the Proceedings of the Entomological Society of Washington her personal experiences with a mite infestation of her scalp that resisted all treatment and was undetectable to anyone other than herself. Traver is recognized as having suffered from Delusory Parasitosis: her paper shows her to be a textbook case of the condition. The Traver paper is unique in the scientific literature in that its conclusions may be based on data that was unconsciously fabricated by the author’s mind. The paper may merit retraction on the grounds of error or even scientific misconduct “by reason of insanity,” but such a retraction raises the issue of discrimination against the mentally ill. This article asks what responsibilities journals have when faced with delusions disguised as science, what right editors have to question the sanity of an author, and what should be done about the Traver paper itself. By placing higher emphasis on article content than author identity, scientific integrity is maintained and a balance is struck between avoiding discrimination against the mentally ill and not preventing patients from seeking needed treatment.     

Theorizing the Temporal Aspect of Ikigai or Life Worth Living among Japanese University Students: a Mixed-Methods Approach

Although cross-cultural and non-Western studies have advanced our knowledge on well-being, many studies have adopted English words including ‘happiness’ as their guiding concepts, which may have limited and biased their insight. The current study is part of a larger mixed-methods project that theorizes how Japanese university students pursue ikigai or a life worth living. The first qualitative study, based on 27 photo-elicitation interviews, generated a grounded theory of houkousei, or life directionality. Our qualitative findings suggested that when students formed explicit associations among the past, present, and future, they gained strong ikigai feelings. These associations were developed either cognitively by mentally associating existing present experiences with the past or future, or behaviourally by strategically choosing current experiences more pertinent to the past or future than alternatives. These actions resulted in two subjective states: life legacy and life momentum. Life legacy was the perception that one’s past had meaningfully contributed to his or her present experiences, life, and self. Life momentum meant the belief that one’s present experiences were helping him or her achieve the desired future. Lastly, having defining past experiences and setting clear goals both facilitated the associative actions. To further validate this theory, we collected online survey data from a national sample of 672 Japanese students. Our quantitative results, based on partial least squares structural equation modelling (PLS-SEM), largely supported our theoretical model. Our findings are discussed in light of the ikigai and eudaimonic well-being literatures.

     

The body one has and the body one is: Understanding the transsexual’s need to be seen

The transsexual individual confronts the analyst with a disturbing otherness. How this otherness is understood, that is, how the analyst ‘looks’ at the patient through her distinctive theoretical lens impacts, in turn, on the patient’s experience and what transpires between them. In this paper the author outlines a developmental model rooted in attachment and object relations theory to provide one alternative way of ‘looking’ at some of these patients’ experiences in the clinical setting. It is suggested that in some cases of transsexuality the primary object(s) did not mirror and contain an early experience of incongruity between the given body and the subjective experience of gender: it remains unmentalized and disrupts self‐coherence leading to the pursuit of surgery that is anticipated to ‘guarantee’ relief from the incongruity. Through an account of work with a male to female (MtF) transsexual who underwent surgery during her five years of psychotherapy, the author explores how a focus on the transsexual’s experience of ‘being seen’, that is, of being taken in (or not) visually and mentally by the object in their state of incongruity, affords another window through which to approach the transsexual’s experience in the transference–countertransference dynamics.