The analyst's caseload as a family: transferences to fellow patients

This article draws attention to a topic that has been mostly ignored in our literature: the manifold transference meanings of our patients' reactions to our other patients. Central aspects of the patient's transference may be displaced onto the analyst's other patients. The author includes clinical examples of hospitalized patients, where such transferences to other patients are often more dramatic and obvious, as well as examples from neurotic patients, where such transferences may be less dramatic and may tend to resolve more readily through interpretation. The displacement of transference feelings onto the analyst's other patients also has important implications for training analyses, where analysands are likely to have multiple relationships with the analyst's other analysands, supervisees, and students.     

Transference as a religious phenomenon in psychotherapy

An analysis is presented of the conventional and far-reaching existential interpretations of the concept of transference. Analogies are drawn between the deepest meanings of transference and interpersonal and religious (man-and-God) dialogue. By way of case illustrations, it is shown that transference from patient to therapist can have implications for the patient's real relationship with God.     

Medication as object

People experience and treat medication as though it were a person: in other words, as an object. Among the many symbolic meanings attributed to medication, this sort of personification, or object representation, is a meaning that medication is uniquely positioned to contain and convey: imbued with intentionality and influence, medication moves beyond the sphere of static, iconic representation and enters the changeable, dynamic object world of action, aim, and agency. Unlike more generic or stereotypic meanings, object representations attributed to medication may reflect the patient's specific dynamics and object relations. These representations are many and mutable, and take on shifting and overlapping forms that evolve with the analytic process. Medication may represent a third person within the framework of an analytic treatment, expanding the analytic dyad into a triad and offering new transference paradigms to explore. The defensive displacement of transferential qualities and attitudes, or split-off parts thereof, from the analyst onto medication can serve as a powerful resistance to the awareness of the transference to the analyst. Clinical examples illustrate the utility and importance of the analysis of medication as object, for both patient and analyst, with particular attention to the transference.     

On fixing and being fixed: Metaphors in psychotherapy

The term to fix is explored with its multiplicity of meanings, and its relevance to such clinical issues as transference and resistance are discussed along with positive and negative denotations and connotations of the term. Cases are also presented to illustrate both positive and negative uses.     

Use of transference interpretations in dynamically oriented individual psychotherapy for patients with personality disorders

The use of transference interpretations in the individual treatment of patients with personality disorders is a controversial issue. Both expressive approaches that stress the importance of transference interpretations and supportive approaches that avoid interpretation of the transference have been advocated by dynamically oriented therapists. Literature is reviewed regarding recommendations for individual psychotherapy and the different views on interpretation of the transference. Available research that has attempted to illuminate the impact of these interventions is also summarized. Although the findings are limited by a number of methodological shortcomings, three implications have emerged. First, a strong therapeutic alliance is imperative for successful exploration of the transference. Second, transference-focused work should be balanced with supportive interventions. Third, the patient's quality of object relations and his or her ability to work within the transference should be considered. However, without further research to guide clinical decision making, clinicians will be left with a confusing array of recommendations and only their intuition.     

Cyberpassion: E-rotic transference on the Internet.

While psychoanalysis has generally been regarded as "the talking cure," written communication from patient to analyst commonly appears within the analytic setting. In our electronic age, e-mail communications from patient to analyst have become commonplace. This paper describes a case of erotic transference conveyed primarily through e-mail messages, and discusses their multiple meanings as an enactment. The unique features of e-mail communication are explored and contrasted with verbal discourse in the analytic dyad.     

Oedipus complex and development of self

The emergence of oedipal object relations is a crucial stage in the development toward individuated adult mentation, distinguished from early stages of psychic life which are transindividual (as in Kohut's "selfobject transference"). The latter continue to function as deep layers of individual psychic life; but the development of oedipal/postoedipal object relations, and advanced psychic structure and functioning based on it, represents a norm in psychoanalytic psychology and therapy. The poet John Keats's ideas about the formation of the individual "soul" (identity as an individual) by the intervention of "circumstances" are cited to illustrate this aspect of the oedipus complex.     

从诠释学的角度看《易经》的解读

任何经典文本的解读实质上皆基于个体诠释的再创造,一部蔚然大观的易学史亦即一部易学诠释史。本文从易学史的演变入手,以诠释学的角度去剖析易学在不同时代解读中所呈现出的特点,并用转意、演绎、得意、生意及复意做一粗线条的概括和梳理,以期对易学发展史有一个较为清晰的认识。     

Further thoughts about "nothing"

Some meanings of "nothing" are delineated according to their acquisition, confluence, and transformation in the course of the child's development of drives, the ego, and object relations. This sketch is illustrated mainly from King Lear.     

Object relations theory in clinical practice

This paper outlines the psychoanalytic techniques derived from ego psychology-object relations theory. It stresses the centrality of affects to interpretation and describes how the focus on dominant object relations in the transference modifies the economic, dynamic, and structural criteria for interpretation. Clinical examples illustrate this technique across a broad spectrum of psychopathology. The technique for genetic constructions and reconstructions in the transference is described, and this approach is contrasted with other object relations theories. Finally, the application of this approach to countertransference and dream analysis is summarized.     

Changes in psychoanalytic ideas: transference interpretation

Interpretation of the transference is central to all psychoanalytic models. Definitions of transference and transference interpretation have changed greatly during the past half-century, influenced by major movements in philosophy, advances in psychoanalytic research and theory, and changes in our understanding of Freud. This paper suggests that historical, relatively simple, concepts of the transference as the reproduction in the present of significant relationships from the past do not adequately meet current clinical and theoretical demands. Modernist views of the transference emphasize as additional sources of transference responses, the role of the analytic background of safety, the constant modification of unconscious fantasy and internal representations, and the interactive nature of transference responses, with important interpersonal and intersubjective components. It is suggested that the evolving modernist views of transference and transference interpretation permit a fuller accounting for transference phenomena and open the way for better informed interventions. A brief discussion of the issue of psychological "truth" and "distortion" as applied to transference phenomena is presented. The themes are illustrated with clinical vignettes.     

The functional correlations of dreams and transference]

The author discusses the old question about an exceptional position of the dream in psychoanalysis in a new way: he postulates the exceptional position of the dream in relation to the transference. Case material is given to illustrate how the dream report goes beyond the level of information insofar it is in itself equivalent to a specific ongoing of the transference process. In conclusion the relations between dream and transference are discussed in regard to a hypothetic functional unit.     

Mortality and Re-enchantment: Conscious Dying as Individualized Spirituality

The emergence of conscious dying in modern society suggests that the redefinition of death as consciousness transference not only challenges the fear of death, but also empowers a personal approach to dying moments. It can be considered a form of individualized spirituality, because the meaning of consciousness transference is not exclusively rooted in institutionalized meanings of the sacred, but redefines the sacred in highly individualistic terms. This change in attitudes towards death reflects a process of re-enchantment concomitant with the individualism of the New Age.     

Object relations in clinical practice

Analysts need to have a theory of object relations at the back of their minds while actually analyzing, but they also need to rediscover this theory constantly in their work with patients. This process of rediscovery depends, I suggest, upon analysts focusing attention not only on what is being communicated by words but on what is being lived out, however subtly, in the transference. This, in itself, can help in reconstructing dynamically something of the patient's history. These issues are discussed in relation to Melanie Klein's theory of object relations and are illustrated with clinical material.     

Psychodynamic Conceptualization and Treatment of Suicidal Patients

This paper discusses psychodynamic perspectives to the conceptualization and treatment of suicidal patients. A review of psychoanalytic and psychodynamic conceptualizations is provided, along with representative case examples of these phenomena. Empirical studies are also reviewed, noting how recent research provides some meaningful insight into the object relations of suicidal patients. Finally, treatment issues are discussed, including comments about transference, dreams, and countertransference. It is concluded that a psychodynamic model is of value when treating patients with suicidal ideation and impulses.     

Analytic preparation: the creation of an analytic climate with patients not yet in analysis

The art and science of beginning an analysis has a life of its own and can be considered in many ways quite apart from its later stages. An incremental path forward is smoothed for patients who are not yet prepared to analyze, and builds eventually into something readily recognizable as an analysis. The term analytic preparation refers to this set of processes. Early on, the analyst is concerned less with facilitating an early replica of an idealized analysis than with facilitating the mutual adaptation of patient and analyst as they begin to negotiate a "thought community." Since analytic preparation is not an entity, it does not neatly overlap in real time with the opening phase as usually described, does not have a discrete beginning or end, and does not abruptly shift mid-stream into analysis proper. Some relations between analytic preparation, analytic interaction, and the interpretation of transference are examined.     

Letting them go - The short-term treatment of an adolescent at risk

This paper is based on my experience of working in an outpatient centre for adolescents at risk in a North London borough. The paper focuses on the pressures encountered when adolescent patients want to stop treatment prematurely, and on the risks of re-enactment in the transference. Clinical material is presented from the treatment of an adolescent girl who resorted to cutting herself when she had to face new developmental stages. Her unresolved Oedipal anxieties as well as possible meanings of the nature of her self-destructive behaviour are explored. Finally I attempt to explore how my struggles with letting her go contributed to her psychic development, which has continued since the end of the therapy.     

Medication and the Fragile Alliance: The Complex Meanings of Psychotropic Medication to Children,Adolescents, and Families

The past 10 years has seen a marked increase in the use of psychotropic medications to treat children and adolescents. Although there is considerable controversy about this trend, it seems inevitable that multimodal treatments including psychopharmacological interventions will need to be better understood and integrated if we are to provide effective treatment to the largest range of patients. In this article, we offer some observations from our clinical experience regarding the effects of medications on the alliance, transference, and family system. In particular, we examine some of the complex psychodynamic meanings of medication that can dramatically affect response to both medication and psychotherapy.     

Transference: current concepts and controversies

In this paper I have presented a brief outline of some of the more important issues regarding transference. To summarize I shall restate ten transference issues heretofore discussed: What should be included in the definition of transference? Should it be defined narrowly or broadly? In what ways can transference be usefully viewed in relation to reality? What merit is there in distinguishing the working alliance from transference? Should self and object transference be differentiated? Should transference neuroses be discriminated from transference reactions on the one hand and from transference psychoses on the other? In addition to sexual and aggressive transferences, should sexualized and aggressivitized transferences, respectively, be distinguished? How may transference be conceived of as a vehicle of cure and yet also as a resistance to cure? What is to be said for the relative merit of the "here and now" versus the "there and then?" What is the role of transference in relation to insight on the one hand and to the therapeutic object on the other? What are some of the basic issues in countertransference?