„Ich möchte an Sie glauben können!“

During daily psychoanalytic treatment something happens that can be described with a term from the Old Testament: “to know”, giving psychoanalytic praxis a religious dimension. The author illustrates this thesis with a case report. First he tries to show how an interpretation of the casuistic material appears in the scope of the well-known concept of religion as an expression of dissoluble narcissistic conflicts. Then he applies Winnicott’s idea of “potential space” as a new scope for interpretation of the case. The conception of the “destruction of the object” according to Winnicott will be related exemplarily to the history of Jesus’ death on the cross and the miracle of his survival. By heeding the world of ideas of Klein and Bion, the author comes to the conclusion that religiosity is an anthropological constant, which cannot be reduced to a pathologic narcissistic event.     

Consummated mother-son incest in latency: a case report of an adult analysis

Reported cases of mother-son incest are very rare in the psychoanalytic literature; the fact of such incest, however, may not be so rare as has generally been believed. A detailed case report of the analysis of an adult with a history of severe physical, sexual, and verbal abuse, including consummated incest with his mother during latency, is considered in the context of other reported studies. The author raises some issues of resistance and countertransference that may influence the reporting, treatment, and perhaps even recognition of cases of mother-son incest.     

Psychoonkologische Therapie und Psychoanalyse: ein Widerspruch?

Psycho-oncological psychotherapy and therapeutic work with severely somatically ill patients seems to be an area of limited interest in psychoanalysis. For example, case reports of psychoanalytic treatment with terminally ill patients are rare. This stands in contradiction to the importance of the fear of dying and death (wish) in psychoanalytic theory construction (e.g. narcissism theory). In addition to the obvious differences between psycho-oncological therapy and psychoanalysis, such as limited time perspective, the need for a flexible setting and dealing with the depth of regression, there are also important similarities and in particular the therapeutic work on early unconscious defence processes and coping with the fear of death. The theoretical and clinical work of the French psychoanalyst Michel de M’Uzan on experiences in psychoanalytic treatment of dying patients are an important example but are not well known in the German psychoanalytic community. The way psychotherapists deal with their own separation anxiety and fear of death is still a major issue and a barely appropriately reflected phenomenon, which possible represents a mutual confrontation (or an impossibility?) of psychotherapeutic work with dying patients.     

Re-reading "Little Hans": Freud's case study and the question of competing paradigms in psychoanalysis

Psychoanalysts have long recognized the complex interaction between clinical data and formal psychoanalytic theories. While clinical data are often used to provide "evidence" for psychoanalytic paradigms, the theoretical model used by the analyst also structures what can and cannot be seen in the data. This delicate interaction between theory and clinical data can be seen in the history of interpretations of Freud's "Analysis of a Phobia in a Five-Year-Old Boy" ("Little Hans"). Freud's himself revised his reading of the case in 1926, after which a number of psychoanalysts--including Melanie Klein, Jacques Lacan, and John Bowlby--reinterpreted the case in the light of their particular models of the mind. These analysts each found "evidence" for their theoretical model within this classic case study, and in doing so they illuminated aspects of the case that had previously been obscured, while also revealing a great deal about the shifting preoccupations of psychoanalysis as a field.     

Minding the gap between positivism and hermeneutics in psychoanalytic research

Two quite different cultures are to be found within psychoanalysis, one more clinical in orientation, more focused on meaning and interpretation, and relying primarily on the traditional case study method, the other more research-oriented, focused on cause-and-effect relationships, and relying primarily on methods borrowed from the natural and social sciences. The history of this divide is reviewed and arguments, pro and con, about the potential contributions of specific types of empirical investigation are discussed. Increasingly, it seems, criticisms concerning the scientific status of psychoanalysis are being responded to by empirical research. This has contributed to a growing recognition within the scientific community of the credibility of aspects of psychoanalytic theories and of the effectiveness of psychodynamic treatment. However, some segments of the psychoanalytic community are concerned that this increase in the quantity and quality of empirical research on psychoanalytic concepts risks creating an empirical one-sidedness, while other segments are concerned that not engaging in systematic empirical research can lead to intellectual isolation, fragmentation, stagnation, and orthodoxy. To counter this polarizing tendency, a recommendation is made for methodological pluralism. Adopting this stance could contribute to an enriched understanding of the clinical process and to the development of new research methodologies to investigate complex psychodynamic hypotheses, thus bridging the gap between the two psychoanalytic cultures, as well as the gap between research and clinical practice.     

Max Eitingon and a Question of Politics

Max Eitingon is thought not to have left behind original theoretical work, despite the fact that he wrote some 40 articles and a dozen psychoanalytic congress reports. He has been almost forgotten over the years, even though he occupied an important political place in the history of the psychoanalytic movement. In recent times, he has again become a subject of attention. In this article the author takes a look at Eitingon as an activist who was intensely involved in the social and political struggles of his time. He represents the political aspect of psychoanalysis on two counts: first, within the psychoanalytic movement, where he had a particular role in the institutionalizing of psychoanalysis, and, second, in relating it to wider social and political ends.     

Psychoanalysis as a creative shaping process2

The author first explains the concepts of creativity, play and aesthetic experience. He then outlines the psychoanalytic process as a creative one that shapes reality. Making a link between psychoanalysis and the humanities, he demonstrates that creative play is a fundamental aspect of the human experience of reality. Aesthetic experiences during the psychoanalytic process are comparable to the play by which children structure their world and artists' activity in following their urge to shape. Furthermore it is shown that creative actualisation testifies to a quasi‐biological need for coherence and structure. Through modern hermeneutics, the truth claims of aesthetic shaping can be established in epistemological terms. The basic principles of hermeneutics‐historicity, linguisticity and communicative experience‐find their psychoanalytic counterparts in memory, representational shaping and transference‐countertransference. Psychoanalysis is demonstrated to be simultaneously a science and an art. On the basis of a case history, aesthetic experience is shown to constitute a specific and unique form of access to psychic reality. Aesthetic experience and creativity do not only aid recovery from ‘bad psychological states’, they are also indispensable for the entire understanding of internal and external reality. It is possible to develop this understanding through a creative psychoanalytic attitude.     

Psychoanalysis in later life

After decades of heeding Freud's admonition against taking patients older than fifty years of age into psychoanalytic treatment, psychoanalysts began to treat them and to report encouraging experiences. This essay is another in a series of case reports that confirms and extends the nature of changes possible in the analytic treatment of elderly patients. In order to demonstrate both specific changes and the possibility of satisfactory terminations with patients of advanced age, the author describes his analytic work with a woman who first consulted him when she was sixty-eight years old.     

Psychoanalytische Kompetenzen

The author presents a project trying to gain as transparent as possible criteria for a competent psychoanalytic practice. The project is oriented at David Tuckett’s (2005) proposal of tracing the implicit knowledge of psychoanalytic experts on quality and of making it explicit. Thirty written comments by experienced training analysts on candidate‘s case reports are utilized. A qualitative content analysis leads to the formulation and explanation of ten psychoanalytic competences. They are framed by a model that conceptualizes psychoanalytic practice by three steps: (1) perceiving unconscious material in a participant–observational frame, (2) reflecting it in a conceptual frame and (3) interpreting it in an interventional frame. The competences of the first frame involve the abilities of evenly suspended attention and abstinence, of working with the countertransference and with psychoanalytic interaction and intersubjectivity, the ability to establish an as helpful experienced relationship, the ability to tolerate and to handle anxiety, tensions and conflicts, and the ability to give psychic space and developmental freedom to the patient. The conceptual frame comprehends the ability to establish, form and end a psychoanalytic process, the ability to utilize theoretical concepts and that of selfreflection. The last but not least ability is related to interpretation in the interventional frame. It is not possible in this survey to characterise the competences in a more detailed way nor to add the indispensable vignettes in order to anchor the competences in practice. Some most interesting questions on plurality and competence in psychoanalytic work are raised.     

Neue Entwicklungen in der allgemeinen psychoanalytischen Psychosomatik

Psychoanalysis has played a pivotal role for developments in psychosomatics both on a conceptual and an institutionalization level. In contemporary psychosomatics there is a focus on conceptual models that concentrate on psychic structure, the processing of emotions and embodiment. Alongside these, the questions arise on how psychoanalytic views on psychosomatic disorders in a more classical sense will develop further and their relevance for current developments. This article gives a brief historical overview of some central concepts in psychoanalytic psychosomatics and shows how these are resumed in what can be distinguished as six aspects of contemporary psychoanalytic psychosomatics. This is demonstrated by a brief case report. The article closes with some proposals for the clinical practice.     

Peter Heller's a Child Analysis with Anna Freud: the significance of the case for the history of child psychoanalysis

A Child Analysis with Anna Freud, a collection of Anna Freud's detailed case notes of her treatment of the young Peter Heller between 1929 and 1932, was first published in English in 1990. Not only does this work give us direct access to Anna Freud's ways of thinking and working at a crucial period in the early history of child analysis; it is also one of the few records of an adult reflecting in depth on the experience of being in analysis as a child. Yet to date this work has received little attention in the psychoanalytic literature. In an attempt to redress this neglect, the Heller case study is placed in the context of Anna Freud's emerging ideas about child analysis. In particular, its significance in the development of her psychoanalytic thinking is investigated in the light of her 1927 book, The Technique of Child Analysis.     

The clinician in the university: Reflections on a South African psychoanalytically oriented doctoral programme

There is increasing interest, both internationally and in South Africa, in strengthening the relationship between psychoanalytic practice and research. This paper reports on a psychoanalytically oriented doctoral programme offered at the University of the Witwatersrand in South Africa. The programme is described in relation to the broader context of the historical relationship of psychoanalysis to the university as well as to the specific context of the history of psychoanalysis in South Africa. Key challenges of the programme, specifically concerning research tensions and methodological and theoretical tolerance, are subsequently explored. The way in which these challenges manifested within a group context illustrates their potential for conflict as well as productive debate. The paper reflects on how this specific programme illuminates and extends some of the broader debates in the field of psychoanalysis.     

Patient's sleep on the analytic couch

Published reports about sleep on the couch have primarily emphasized its preoedipal (especially oral) determinants and defensive purposes. A detailed case is presented in which sleep became the central symptom of the transference neurosis. The primary determinants of the symptom were from the phallic-oedipal stage of development. Like other symptoms, the sleep symptom was a reliving of earlier experiences and was analyzed primarily through the transference. The analytic data from the case are used to illustrate resistance as an ally in the psychoanalytic process.     

Lines of advance in psychoanalytic psychotherapy

Freud's 1919 paper is taken as a starting-point to review how far we have advanced towards fulfilment of his prophetic remarks about the need to develop psychoanalytic psychotherapy for the masses. A glance is taken back to some of the circumstances and characters involved in Budapest where the paper was given at the 1918 congress, where there was much talk about the need to do something about the war neuroses. Similar pressures led to the founding of the Tavistock Clinic and Cassel Hospital in the UK, long before the start of the NHS. The pressures of both world wars advanced the applications of psychoanalysis; the next wave of pressures may come from NHS changes and entry into Europe. The history of psychoanalytic psychotherapy in the UK is also considered via looking briefly at the history and development of psychoanalytic publications, of the Tavistock Clinic, of psychoanalytic training, of child psychotherapy and the emergence of adult (non-medical) psychotherapy. There have always been tensions between exponents of the pure gold of analysis and the needs of its wider applications. More flexible arrangements and boundaries are necessary if we are to spread psychoanalysis beyond London and to fulfil Freud's own hopes about the large-scale application of psychoanalytic therapy.     

False Memories,Negative Affects,and Psychic Reality: The Role of Extra‐Clinical Data in Psychoanalysis1

Psychoanalysis as a treatment originated in the idea that neurosis is related to the ways in which individual psychic reality departs from actuality. Psychic reality includes memories, beliefs and their associated affects and fantasies connected with an individual's experience of the inner and outer world. The psychoanalytic determination of what meaningful memories or beliefs are inaccurate, distorted or false ordinarily relies upon principles of intra‐clinical validation. By itself, however, intra‐clinical validation is subject to limitations and pitfalls that conviction alone about what is actual cannot circumvent. Despite this fact, there are remarkably few analytic case reports demonstrating false or signifi cantly distorted memories through the use of data obtained from outside the consulting room. This paucity of reports may be related, at least in part, to the belief that the use of extra‐clinical data is essentially unanalytic or supports resistance. Based on the views that (a) psychic reality cannot be regarded as exclusively subjective or objective but is inherently both; and that (b) a goal of analysis is to achieve a different, acceptable and more accurate view of reality, the authors report a clinical case involving a confi rmably false pivotal memory and its associated negative affects. They discuss theoretical and technical considerations in utilizing extra‐clinical data during the treatment process.     

'Talk to me baby, tell me what's the matter now': Semiotic and developmental perspectives on communication in psychoanalytic infant treatment

Infants suffer to a considerable degree from disturbances in nursing, sleep, mood, and attachment. Psychotherapeutic methods are increasingly used to help them. According to case reports, psychoanalytic work with infants and mothers has shown deep‐reaching and often surprisingly rapid results, both in symptom reduction and in improved relations between mother and child. The clinical urgency of the method makes it important to study its results and theoretical underpinnings. Among the theoretical issues often raised in discussions on this modifi ed form of psychoanalysis, those addressing the nature of communication between analyst, baby, and the mother are the most frequent. For example, how and what does an infant understand when the analyst interprets to her? What does the analyst understand of the infant's communication? These issues are addressed by investigating the infant's tools for understanding linguistic and emotional communication, and by providing a semiotic framework for describing the communication between the three participants in the analytic setting. The paper also investigates problems with the traditional ways of using the concept of symbolization within psychoanalytic theory. The theoretical investigation is illustrated by two brief vignettes from psychoanalytic work with an 8 month‐old girl and her mother. demand for the breast. Like the two lovers in the blues, they seemed to be slaves to     

The spit and image: a psychoanalytic dissection of a colloquial expression

"He is the spit of his father" or "he is the spit and image of his father" is a colloquial expression that has graced informal English for many centuries. When a "spitting image" made an entrance in the manifest content of an analysand's dream, it became possible to add a psychoanalytic point of view to an etymological and anthropological record. After discussing both this clinical case and an "anthropological case history," the author examines the subtle but complex genesis of this colloquial expression from a speculative applied psychoanalytic perspective.     

Strategic self-marginalization: the case of psychoanalysis

Marginality is an important concept in the history of science, though it is often used in a manner that presumes marginality to be a static designation. We contend that the dynamics of marginality are crucial to the history of psychoanalysis, a discipline that has moved between dominant and marginal positions. We address psychoanalytic marginality via three specific "cases": the marginalization among Freud and his followers when psychoanalysis was an emergent discipline; the marginality trope in Erich Fromm's popular psychoanalytic writing when psychoanalysis was orthodoxy in American academic psychiatry; and the rhetorical marginality of psychoanalysis in Sweden as psychoanalysis entered a decline within psychiatry. Our aim is to show that marginalization and self-marginalization serve interpersonal, social, and professional strategies.     

A Kleinian view of psychoanalytic couples therapy: Part 1

This paper will investigate the central aspects of the psychoanalytic treatment of couples. The concept of analytic contact is introduced and the importance of each party of the couple being witness to the other party's response to analytic contact is discussed. Emphasis will be placed on issues of thinking, projective identification and the concept of container‐contained. Part 1 of the paper will focus mainly on theoretical issues but will then utilize one clinical case to illustrate some of the theoretical points. Using extensive case reports, Part 2 will continue to provide the reader with an in‐depth view of the important process of a couple's therapy within a psychoanalytic framework.     

Telephone analysis: compromised treatment or an interesting opportunity?

Under the pressure of societal changes, today many analysts agree to conduct parts of an analysis over the telephone. However, little has been written about particular ways in which use of the phone affects the psychoanalytic process. The author focuses on the impact of the phone on psychoanalytic treatment and particularly on one of its potential advantages, i.e., the combination of a continuity that intensifies the treatment and physical distance between analyst and patient, making this intensity less threatening. Two detailed case reports illustrate how this combination facilitated the growth of affective tolerance and enabled these two patients to bring their emotional experiences from phone sessions into the consulting room.