Response to MacIntosh’s Systematic Review of Psychoanalytic Couple Therapy: A Brief Note from the Classical Perspective

ABSTRACT

Working with couples from a classical perspective can be thought of as an oxymoron, unlike working from object relations and relational viewpoints, often seen to be the more natural fits. This article offers a fresh look at those parts of the classical perspective that relate very clearly to working with two partners in a couple. Freud’s theories in Three Essays on the Theory of Sexuality (1905) and On Narcissism (1914a) provide theoretical background for the work. Concepts such as transference (between partners, between the partner[s] and the therapist) and countertransference are shown to be manifested in complex ways with couples. Being mindful of unresolved developmental issues—for example, Oedipal and separation-individuation issues—which may have played a part in partner choice and in the resulting problems, allows the therapist to offer deep interpretations of within- and between-partner conflicts. Interestingly, unresolved Oedipal issues, particularly, may form an important part of the countertransference.     

Transference and countertransference issues with sexually abused clients

Abstract

This paper explores some of the therapeutic issues which arise when working with sexually abused clients. It is suggested that both the client and the therapist may at moments take any of the three positions in the Oedipal triangle and that the mother, father and child status are interchangeable in the transference and counter-transference. It is also suggested that the Oedipus myth represents the failure of a family to contain sexual and murderous passions. I describe a Hindu myth which takes a similar triangle of passion but illustrates how containment is possible. It is proposed that this implies we need to re-evaluate the presence of the erotic in therapy in a more positive light. It is further suggested that the sexually abused client needs to experience the containment of passion if a healing process is to occur.     

Revenge of the fathers Incest and the male therapist

Abstract

This paper argues that the socio-psychological foundation of incestuous relations between father and daughter resides in the primordial rivalry between father and son and is a manifestation of the property relations existing between them throughout the period of patriarchy. After an attempt to trace this rivalry along a path through Western civilization by summarizing evidence from both religious and mythological sources, I introduce it into our own times by using two case illustrations from my own clinical work. Here I claim that when a male counsellor/therapist engages a sexually abused female patient he, at the same time, encounters the incestuous father in a potentially rivalrous struggle over the patient. For genuine healing to take place in the patient, the counsellor/therapist must form an alliance with the father and utilize his hidden value in enhancing his own therapeutic capability.

I began by stating that particular clinical complexities exist when male therapists engage with female clients who have been the victims of paternal incest. I then postulated the idea that the socio-psychological foundation of such relationships is the primordial rivalry between father and son and is in fact a particular manifestation of the property relations existing between them. I then traced this father/son rivalry along its path down through Western civilization via Jerusalem and the Judaic/Christian religions, and Athens with its early creation myth, and the somewhat later myth of Oedipus. I then pursued the course of its influence to our own times, to the incestuous father/daughter relationship, and, using examples from my own clinical work, I attempted to show how this father/son rivalry survives as a powerfully pervasive influence in the clinical relationship between the female patient who has experienced paternal incest and her male therapist.     

Architecture and psychoanalysis. Nathaniel Kahn and the search for the father

Abstract

This text is intended as a contribution to the study of the profound mutual relations between architecture and psychoanalysis. Architecture creates representations that conceal unconscious forms of thought; psychoanalysis helps to explain the meanings of these representations – forms of construction and forms of the psyche. The multifaceted work of psychoanalyst Christopher Bollas – his thoughts on the relationships between psychoanalysis and architecture, on the vitality of objects, on the creative implications of the Oedipal relationship – serves as a critical and decisive instrument for the authors’ inquiry. The issue of the “vitality of objects” as described by Bollas also concerns – but only in part – the architectural “object.” One modern form of architecture with an inordinate capacity empathy has to be Louis Kahn’s. Kahn’s youngest son , Nathaniel, lost his father when he was still a child and hardly had a chance to get to know him. After becoming an adult and an established film-maker, he managed to recover his father in two ways: by discovering him in his works, with their powerful affective impact; and by drawing from those very works of his father to enhance his own creative process in his filmic art. As it turns out, it is this very process that has allowed for an emblematically positive resolution of the Oedipal relationship.     

Surviving Destruction and Finding Connection: Play Therapy with an 11 Year Old Boy

ABSTRACT

How do child therapists manage the most difficult and emotionally intense moments in play or maintain safety with our most emotionally challenging patients. This extended case presentation presents material from a play therapy treatment with an school aged old boy. The treatment shows how the therapist struggled to maintain boundaries and safety, while maintaining space for the patient to share his most disturbing self-states in order to help the patient find connection with the therapist and developmental advancement.     

Zwei Wege am Ödipuskomplex vorbei

Two pathological constellations are presented that prevent from resolving the Oedipal complex. Both have in common the poor resilience of the negative Oedipal constellation. In the first version, a rivalry with the father is avoided, acknowledgement and idealization do not take place, but the father’s position is taken over in a regressive surreptitious way. The second way to avoid resolving the Oedipal constellation is based on narcissistic omnipotence. During Oedipal development the child – owing to the behaviour of the parent of the other sex – becomes convinced to be himself the preferred partner of father or mother. This development is illustrated by a case study.     

Contributors

Abstract

The profound psychic differences between the two human sexes are also reflected in their diverse psychopathology, even though the basic clinical forms remain common for both. In this study the problem of the psychoanalytic difference between the two sexes is discussed within the framework of psychotic situations; in intrapsychic relationships with the mother and the father, and between the patient and the therapist and with his sex. The problem of masculine and feminine psychosexuality is furthermore seen in a different light, in accordance with its pre- or postoedipal configuration.     

Father Involvement in Immigrant and Ethnically Diverse Families from the Prenatal Period to the Second Year: Prediction and Mediating Mechanisms

This longitudinal study focused on fathers’ involvement from the prenatal period through infants’ first year in Dominican immigrants (n?=?73), Mexican immigrants (n?=?65) and African Americans (n?=?66) residing in New York City. Fathers’ prenatal involvement, the quality of the mother–father relationship, fathers’ postnatal involvement with their 1- and 6 month olds and fathers’ involvement with their 14 month-olds (i.e., time spent with infant; eating meals with infant; activities with infant) were examined. Father involvement was uniformly high and stable. Fathers’ prenatal involvement predicted involvement at 14 months, and the quality of the mother–father relationship mediated these associations. Father ethnicity and residency moderated associations between the father–mother relationship, father postnatal involvement and father involvement with 14 month olds.     

Male and female internal images in a case of frigidity

Abstract

This is the case of a young woman suffering from a narcissistic personality disturbance with Oedipal aspects. The development of the analytic treatment is stressed through the analysis of her dreams. The analytic setting provided an appropriate mirroring Self-object. Thereby the patient has had the opportunity to express her own defective female grandiose Self, which was at the base of her disturbances.     

New frontiers in psychoanalysis – in our international community

The paper discusses what the author calls “The seduction by the father”. It would occur when, in the Oedipus complex, the father reverses his role: instead of being the one who castrates, he seduces. Seduction here is understood in the sense that he does not act as the one who imposes limits to the child. Consequently the child can not project his hostile impulses onto the father.

Based on clinical data, the Author says that, in the male child, the seduction by the father hampers the transformation of the two Oedipal attitudes towards the father into identifications. The consequences of this fact upon the construction of the “nostalgia of the father's protection” are discussed, so as the transformation of this father into the symbolic father.     

Development and Psychometric Evaluation of the Father Engagement Questionnaire

While there has been increasing interest in promoting father engagement in parenting interventions for child wellbeing, both research and practice endeavors have been hindered by a lack of a measure of father engagement practices. This paper reports the development and evaluation of a comprehensive, practitioner-report measure of father engagement practices–—the Father Engagement Questionnaire (FEQ). Practitioners (N?=?589; 84.5% females; mean age?=?38.56) involved in delivering parenting interventions in Australia completed the FEQ, along with background demographics and questions regarding their own and organization’s practice. A separate sample of 28 practitioners completed the FEQ twice, with a two-week interim, to assess test–retest stability of the measure. Exploratory factor analysis revealed five factors corresponding to the measure’s five intended content areas: Confidence in Working with Fathers, Competence in Using Engagement Strategies, Perceived Effectiveness of Engagement Strategies, Frequency of Strategy Use, and Organizational Practices for Father Engagement. Each of these scales demonstrated adequate internal consistency reliability and test–retest stability. As the five scales appear to be related but distinct, it is recommended that the FEQ is used as a multidimensional measure of father engagement. In terms of predictive validity, higher scores on the Confidence in Working with Fathers, Frequency of Strategy Use, and Organizational Practices for Father Engagement scales were associated with a higher likelihood of practitioner-reported father attendance. The results provide support for adequate psychometric properties of the FEQ as a research and clinical tool for assessing and monitoring father engagement practices.     

Frank in mind: a journey to self

Abstract

This paper describes two years’ intensive psychotherapy with an 11 year old boy I shall call Lou, who as a result of traumatic experiences in his early life, struggled to integrate a robust sense of self and in particular to find accord with a sense of himself as male. The impact of maternal depression, paternal gender dysphoria and domestic violence are discussed in relation to this young boy’s capacity to resolve the ordinary Oedipal challenge and find narcissistic value in a male body image to consolidate his gender identity. Concomitant difficulties with separation from his mother and aggression towards himself and others significantly impacted his ability to manage in a mainstream school environment and he was excluded at the time the therapy began. A clinical narrative is presented which illustrates Lou’s journey in psychotherapy, where he began to engage and allow links to be made. He sought to understand his position in a world that did not make sense to him, to face a hitherto ‘unthinkable’ past and to integrate disparate aspects of himself including a male gender identity. Notably Lou’s creation of ‘Frank’ constructed from dead, lost and reanimated objects is described and the actual and symbolic functions of this therapy object are discussed in relation to his internal development and the progress of the work. Parallels are drawn with Mary Shelley’s novel Frankenstein, where the creature strives for psychological birth and understanding. Lou and I struggled in the paradox of the themes of his narrative; a male/female father; potency and castration; corruption and repair and how to be a boy, held and helped in part through the paternal function of a female therapist.     

Ordinary Unconscious Communication in the Therapist/Patient Relationship

ABSTRACT

In this article, I consider the ways in which unconscious communication between therapist and patient is omnipresent in psychoanalytic work. To consider unconscious communication between therapist and patient is to consider psychoanalysis, at its core. The phenomenon of unconscious communication between patient and therapist is a quotidian event. It defines its essential listening stance, with variations associated with different theoretical perspectives. I present several clinical vignettes to illustrate the phenomenon and consider some different theoretical perspectives that bear on the therapist’s uses of self in engaging the ways that one unconscious informs another.     

Oedipus matters

Abstract

Using experience of working clinically in South Africa, a powerfully racialized society, this paper argues that the Oedipal period, associated in psychoanalytic theory with the formation of gender identity and the shaping of sexual desire, is also a period during which perception of racial identity affects entry into the social world. During this pivotal developmental period, marked by awareness of encounters with gender difference and experiences of erotic exclusion and inclusion, children also become aware of racial differences and their effects on class, privilege and custom. The paper suggests that the anxieties, competitive energy, hope, hate and dread that accompany the child's Oedipal strivings are frequently compounded by encounters with forms of social difference both in and beyond the family. Assumption of a gendered identity, in many contexts, is inseparable from the conscious and unconscious habitation of a racialized identity, which emerges during exactly the same period. Just as our gender identity is both simple and infinitely variable and complex, our awareness of our race is also on one level simple – ‘black/white’ – and on another extremely complex. The paper argues that the working through of Oedipal anxieties will cast light and shadow on every intimate relationship, and will also determine whether other kinds of difference, including racial difference, are met with fear or competitiveness, idealization or denigration, joyful curiosity or withdrawal. The argument draws on post-Freudian, relational and self-psychoanalytic theory, and emphasizes the variability of developmental paths and their construction in powerful social, economic and political contexts, all of which have fundamental effects on biology and bodies. Major influences on the argument are psychoanalytic gender theorists, specifically Jessica Benjamin and Jody Messler Davies, and the work of Franz Fanon.     

Heathen Talk: Psychoanalytic Considerations of Eating Disorders and the Dissociated Self

ABSTRACT

An intermix of direct behavioral intervention incorporated in a psychoanalytically oriented stance is needed to treat the eating-disordered patient. Symptomatic behaviors too quickly get entrenched and need to be urgently addressed. Particularly with the eating-disordered teen, treatment goals must include immediate intervention with eating behaviors while, at the same time, attempting to reach the disowned part of the patient, often hidden behind bingeing, purging, or other disordered behaviors. This work involves an expansion of the unwitting but often hierarchical structure of contemporary treatment. Understanding dissociation as an interpersonal enactment as opposed to developmental impairment allows patient and therapist to work in tandem to search for the parts of the patient hidden behind food and weight obsessions. The goal is not merely symptom reduction but also to find the part of the patient who is reluctant to enter the room.     

Altruism and Boundary Violation

ABSTRACT

The desire to help others is a common motivation for becoming a therapist, and boundary crossings are an expectable part of psychotherapeutic work. However, progression to boundary violation is rare. The concept of an altruistic boundary violation is presented and illustrated with detailed clinical material drawn from the analysis of Mrs. A,¹ a generally ethical therapist, whose violation of the therapist/patient boundary with her patient, M, began as an altruistically motivated enactment and boundary crossing. In Mrs. A’s case, and arguably in all similar altruistic boundary violations, a specific fit existed between patient and therapist. The intense need to rescue this particular patient was fueled by Mrs. A’s history of early physical and abandonment trauma, which increased her vulnerability to overidentification with her traumatized patient. The stress of relocation to another city and closing her practice further magnified her susceptibility. The complex clinical, professional, ethical, and legal issues inherent in consulting on such a case are discussed. I describe my countertransference and my parallel enactment, an initial crossing of the boundary between the roles of supervisor and therapist.     

The internal world of the juvenile sex offender

This paper explores the consequences of the therapist's two successive pregnancies on a female patient. The second pregnancy was felt to be particularly difficult and disturbing. One of the central reasons was that after the patient's birth, the mother had a disabled child, followed by a stillbirth and soon after that the father left to marry another woman. Using Freud's concept of deferred action I will argue that my second pregnancy revised these earlier traumatic experiences.

The patient seemed to have incorporated and identified with a damaged maternal object that at the time of the original trauma was left husbandless, depressed and suffering from panic attacks. Although the therapist's healthy pregnancies seemed to reassure temporarily, it was difficult for the patient to hold onto a view of a helpful and productive therapist, one separate from this damaged internal mother. This was particularly so during and after the second pregnancy, where there was a marked absence of an idea of a third object, a father or a husband, who could help the patient deal with this pregnancy, her only escape was to retreat and act out.

The acting out was in part identification with a fleeing father and in part a defence against the absence of such a third object, so that it was used as a way of avoiding claustrophobic feelings of being trapped with the damaged mother. Her feelings of triumph then produced much guilt, and impeded reparation.

Another important issue that two successive pregnancies bring, are feelings of guilt in the therapist for exposing the patient to two major disruptions. In this patient's case it exacerbated the internal reality of a damaged maternal figure.     

Treatment of a four-year-old victim of incest

Abstract

A case study describing the use of behavior techniques in the treatment of a four—year—old sexual assault victim is presented. The target behaviors included eating, phobic behaviors, self—injurious behaviors, and comments made about the father (the perpetrator) and the paternal grandmother. The child's mother served as both data collector and therapist. The study demonstrates that child victims can experience a sexual assault trauma syndrome similar to that manifested by adult victims. Additionally, the findings illustrate that a simple behavioral intervention implemented by a parent can be effective in treating young sexual assault victims.     

Murdered father; dead father: Revisiting the Oedipus complex1

This paper recovers the notion of the sacrifice of sexuality as the central, tragic, element of the oedipal structure. This notion has been largely abandoned in the psychoanalytic literature that has tended to reduce the oedipal structure to processes of exclusion. The paper traces the development of the theoretical and clinical transformations of Freud ’s ideas on the role of the father and suggests that they allow us to more fully comprehend the Oedipus complex proposed by Freud. A paradox is explored: the killing of the father is, in Freud ’s view, the requirement for the creation of the social order which, from then on, prohibits all killings. The father, however, has to be killed metaphorically only, as the actual exclusion of the father lies at the origin of so many psychopathologies from violence to the psychoses and perversions. The paper analyses the fundamental asymmetry that is present in the Oedipal structure and suggests that the three elements of the oedipal triangle constitute the law (of the dead father, that institutes the sacrifice of sexuality), desire (for the lost object) and identification (with both father and mother). Two clinical examples are discussed. In the first, one can identify a perverse structure in which the father has been murdered; in the second, there is a progressive construction of the dead (symbolic) father in the analytic process.