Nymphea: from psychic breakdown to the emergence of subjectivity

In the first part of the paper the author presents an account of the analysis of a woman who is psychically extremely disturbed. This clinical presentation focuses on the unfolding of the transference process, and on the countertransference difficulties encountered during the course of the treatment which lasted more than ten years. In the second part of the paper the author proposes a theoretical approach to the breakdown experienced by the patient, and puts forward the hypothesis that there was insufficient differentiation between her internal objects and the archetypes, and that this prevented the development of symbolization. The author proposes the idea of a collapse between internal and external objects, which destroys the space necessary for representation and symbolization that normally arise between the two poles of the object. The account of this transference process between the analyst and the patient is thus seen as the account of the (re)construction of true internal objects, and of the resumption of a symbolic process to make possible the development of subjectivity.     

Hippocampal damage and exploratory preferences in rats: memory for objects, places, and contexts

Rats have a natural tendency to spend more time exploring novel objects than familiar objects, and this preference can be used as an index of object recognition. Rats also show an exploratory preference for objects in locations where they have not previously encountered objects (an index of place memory) and for familiar objects in contexts different from those in which the objects were originally encountered (an index of context memory). In this experiment, rats with cytotoxic lesions of the hippocampal formation were tested on all three versions of the novelty-preference paradigm, with a 5-min retention interval between the familiarization and test phases. Rats with sham lesions displayed a novelty preference on all three trial types, whereas the rats with hippocampal lesions displayed a novelty preference on Object trials but did not discriminate between the objects on Place trials or Context trials. The findings indicate that hippocampal damage impairs memory for contextual or spatial aspects of an experience, whereas memory for objects that were part of the same experience are left relatively intact.     

An existential‐phenomenological counter‐theory of transference

The hypothesis of transference has become such a fundamental assumption for many therapeutic practitioners, that it is rarely questioned either in terms of its theoretical value or its function. This paper will critically examine the notion of transference from an existential‐phenomenological perspective and will argue the case for an alternative perspective. Further, it will seek to demonstrate that numerous and significant logical and applied problems arise with regard to the hypothesis of transference—problems which have a major negative impact upon the therapeutic relationship in general and upon the possibility of ‘encounter‘—or ‘meeting‘—between therapist and client. Finally, the paper will seek to show how, in many cases, the adoption of the hypothesis of transference can be seen as a defensive and power‐preserving (or enhancing) activity on the part of the therapist whose benefit to the client is, at best, questionable.     

On the countertransference of the patient: Transformations of the psychoanalyst's 'theoretical self' and their possible articulations with the vicissitudes of the analytic relationship

In this paper the author examines one of the many levels of the analyst/analysand relationship: the possible interaction between the analyst's mental routes in relation to theories (also meant, but not only, as internal objects) and the vicissitudes of the psychoanalytic relationships with his patients. The author assumes that an important variable affecting the transformation of certain therapeutic relationships is the change that takes place in the relationship between the analyst and that part of his internal world where his theories find their place. He names this part of his internal world 'theoretical self', and 'precipitates of the analyst's theoretical self' those complex formations, akin to more or less cohesive conglomerates, that are formed by his relationship to theories and to psychoanalytic institutions, and by the various, 'personal' internalised objects. The psychoanalyst will relate to these precipitates in a variety of ways, and he will make use of them mostly at an unconscious level in his analytical work; and his patient is likely to 'react' to them, almost chemically. The author also offers some working indications: the psychoanalyst, despite his knowledge of some aspects of his own countertransference, is in fact lacking in knowledge, unless he constantly does some extra work focusing on how his mental position (i.e. the relationship with the precipitates of his theoretical self) may intervene in any of the therapeutic relationships that he establishes-not necessarily in the same way in each of them. The author also illustrates his reflections and conceptualisations by reporting dreams and excerpts from sessions taken from three psychoanalytic treatments in the course of several years.     

TRANSFERENCE BEFORE TRANSFERENCE

This paper is predominantly a clinical presentation that describes the transmigration of one patient's transference to another, with the analyst functioning as a sort of transponder. It involves an apparently accidental episode in which there was an unconscious intersection between two patients. The author's aim is to show how transference from one case may affect transference in another, a phenomenon the author calls transference before transference. The author believes that this idea may serve as a tool for understanding the unconscious work that takes place in the clinical situation. In a clinical example, the analyst finds himself caught up in an enactment involving two patients in which he becomes the medium of what happens in session.     

Silent dialogues in the analytic relationship

Abstract

In borderline or even narcissistic patients, the relation to the objects is built on the basis of omnipotent control, so that those patients present difficulties related to mourning for the loss, as well as for the independence, of the objects. Their basic trait is a huge inability to recognize the separateness of others, together with an excessive use of primitive defense mechanisms, such as projective identification. Each experience that contains the danger of re-experiencing the primal separation poses an attack on the analytic setting, in order to avoid such a re-experiencing. Those attacks sometimes take the known form of acting out, whereas other times they are limited to a special use of speech, which lacks any communicational faculty and is used rather as a weapon. This special climate affects the analyst, causing specific countertransferential reactions. Nowadays, we tend to consider such a communication not mostly as an obstacle, but rather as an opportunity, allowing the analyst to comprehend the patient, through his countertransference, and create a meaning to replace the void those patients usually experience. The transference and countertransference enactments, their silent dialogues taking place in the analytic setting, are those which progressively give meaning in this primitive non verbal communication.     

Psychoanalysis and the Growth of Knowledge

This paper discusses two kinds of complexities inherent in psychoanalysis' concept of transference. The first kind: transference emotions usually appear in the shape of polarities—that is, an emotion is accompanied by its opposite that may be manifest or latent. This is true both of emotions that are split off and ambivalent. In addition, two or more such polarities often co-exist, running like parallel tracks, e.g., an aggression polarity together with a dependence polarity. A clinical vignette illustrates this train of thought. The second kind: Starting from Winnicott's concept of transitional phenomena, the epistemologicaI status of the transference concept is discussed. Transference phenomena take place in an intermediate area between reality and phantasy, and between past and present. The ensuing paradoxes that will characterize the concept-formation have to be accepted and respected. Some technical consequences of these complexities are discussed.     

On internal object relations

This paper gives an account of the author's attempts to come to terms with the concept of internal object relations, and to find an appropriate theoretical place for it within non-Kleinian mainstream theory. It is proposed that the internal object be regarded as a structure in the nonexperimental realm, being built up during development on the basis of the child's subjective perceptual and fantasy experiences. The internal objects in turn influence perception, thought, fantasy, current object relations, and transference. From the point of view of the clinician, the concepts of internal object and of internal object relation act as useful organizing constructs for both analyst and patient. Finally, the suggestion is made that internal objects can be regarded as the source of internal "presences" with which the person constantly unconsciously interacts.     

Effects of action relations on the configural coding between objects

Configural coding is known to take place between the parts of individual objects but has never been shown between separate objects. We provide novel evidence here for configural coding between separate objects through a study of the effects of action relations between objects on extinction. Patients showing visual extinction were presented with pairs of objects that were or were not co-located for action. We first confirmed the reduced extinction effect for objects co-located for action. Consistent with prior results showing that inversion disrupts configural coding, we found that inversion disrupted the benefit for action-related object pairs. This occurred both for objects with a standard canonical orientation (e.g., teapot and teacup) and those without, but where grasping and using the objects was made more difficult by inversion (e.g., spanner and nut). The data suggest that part of the affordance effect may reflect a visuo-motor response to the configural relations between stimuli. Experiment 2 showed that distorting the relative sizes of the objects also reduced the advantage for action-related pairs. We conclude that action-related pairs are processed as configurations.     

Anorexic and bulimic states of mind in the psycho-analytic treatment of anorexic/bulimic patients and psychotic patients

SUMMARY

This paper discusses the relationship of bulimic and anorexic states of mind, and their interchangeability as manifested in the transference. The anorexic making bulimic-like greedy demands upon his/her objects. The bulimic showing all the qualities manifestly presented by the anorexic, an appetiteless approach to possibilities and peculiar searches in a non-specific fashion for satisfaction. Clinical material for discussion is presented from the analysis of three patients — one of whom was psychotic.

The paper attempts to show how in the transference in the true anorexic and bulimic, attacks are directed towards the awareness of the meaningful and intended specificity and function of all objects, so that any specific function can be mis-directed or nullified by the patient. The paper shows how some of these characteristics can appear as well in the treatment of borderline cases and affect the countertransference of the therapist.     

Immersion versus interactivity and analytic field

Losing oneself in a story, a film or a picture is nothing but another step in the suspension of disbelief that permits one to become immersed in the 'novel' of reality. It is not by chance that the text-world metaphor informs classical aesthetics that, more than anything else, emphasizes emotional involvement. On the contrary, as in much of modern art, self-reflexivity and metafictional attention to the rhetoric of the real, to the framework, to the conventions and to the processes of meaning production, all involve a disenchanted, detached and sceptic vision--in short, an aesthetics of the text as game. By analogy, any analytic style or model that aims to produce a transformative experience must satisfactorily resolve the conflict between immersion (the analyst's emotional participation and sticking to the dreamlike or fictional climate of the session, dreaming knowing it's a dream) and interactivity (for the most part, interpretation as an anti-immersive device that 'wakes' one from fiction and demystifies consciousness). In analytic field theory the setting can be defined--because of the weight given to performativity of language, to the sensory matrix of the transference and the transparency of the medium--the place where an ideal balance is sought between immersion and interaction.     

Association between objects and body parts mediated by function

Recent accounts of conceptual knowledge suggest that the specific gestures/actions that should be performed in order to use an object for its intended function are an integral part of its mental representation. If this is true, then the information regarding which body part needs activating to interact with the object should also be part of such representation. Starting from the assumption that not only artefacts (i.e., tools), but also natural objects (i.e., fruits and vegetables) have a function, the present study investigates the existence of a link between a specific object and the effector involved in its use. The Implicit Association Test (IAT) paradigm was adopted to test for an association between natural objects and mouth, and between artefacts and hand (Experiment 1) or foot (Experiment 2). Results showed selective links between objects and effectors, based on which body part is needed to carry out the object's function.     

Silence and communication: nonverbal dialogue and therapeutic action

The subject of this article is silence as communication, with the starting point in the silences of three patients in treatment—in one of them his silences lasted up to a year. Silence is also seen as a specific dimension linked to speech, as the treatment of a third patient shows. The nonverbal interaction between patient and analyst is illustrated. This interaction led to a developmental process in each of the patients, characterized by fusion and separation processes, which included a development of three-dimensionality. The curative process taking place in each of the three, not through verbalisation but through the relation, is understood in the light of Modell's (1990) concept of “dependent/containing transference”. The treatment results demonstrate that the “dependent transference” is curative in itself when the therapeutic setting is maintained. The analyst's inner work during the dependent transference is described: a form of nonverbal participation and joint creativity in the intersubjective field.     

The transference neurosis in Freud's writings

This paper reviews the evolution of the concept of transference neurosis in Freud's writings. It suggests that the language in which the concept of the transference neurosis is originally expressed by Freud includes an idea of the analyst as aggressively pursuing the analytic cure by waging a solitary battle against the patient's disease. With the representation of the death drive and the larger role accorded to sadism as its external manifestation in Freud's revised drive theory of 1920, the patient becomes the ally; resistance, in the sense of the conservative forces, not disease, in the sense of libidinal conflict, becomes the enemy. It is thus difficult to speak of a transference neurosis in the circumscribed way Freud originally meant it, and he ceased to use the term after 1926 rather than redefine it to fit his broader perspective. In this broader perspective, relative resolution of conflict replaced radical liberation of the patient from disease. That Freud did not redefine the term does not imply that he discarded it, or that we necessarily should. This paper suggests that Freud implied a functional distinction between transference as transforming agent and transference neurosis as result of that transformation. That distinction defines psychoanalytic cure in terms of the understanding of a symbolic transformation which is, through the transference neurosis, reexperienced as part of the psychoanalytic process.     

Dancing With the Unconscious: The Art of Psychoanalysis

This article examines psychoanalytic work as an art and uses the metaphor of dance between two unconscious minds to describe the rich creativity of mental life. Free association, transference/countertransference, and dreamwork are each discussed for their creative dimensions and their coupling in the cure. A compelling session with dream analysis of a transsexual patient is presented verbatim (along with the author's inner thoughts) to illustrate the art of dance that takes place between analyst and analysand.     

The many faces of self-harm

This paper explores why open dialogue on the subject of erotic transference and countertransference is so difficult and attempts to offer an understanding of these phenomena which might enable counsellors to work more confidently with it. It also briefly examines the author's own research on therapists' thoughts and experiences of erotic transference, seeking to differentiate between inappropriate sexual contact between clients and therapists and the experience of erotic transference in the context of therapy as a reworking of the Oedipal relationship. Case examples illustrating the experience of countertransference within the therapeutic situation and how its presence can act as a help or a hindrance are offered. The paper concludes by examining the need to reflect on the erotic transference in therapeutic work and proposes its usefulness as a therapeutic tool. Suggestions about how the erotic transference can be managed to therapeutic effect are also explored.     

MAPPING THE LANDSCAPE: LEVELS OF TRANSFERENCE INTERPRETATION3

The author argues that there are distinctly different kinds of transference interpretation, each of which might be valid in particular circumstances in analysis, but which contain and imply different understandings of what is meant by a ‘transference interpretation’. She suggests that transference interpretations may be at any one of four different levels, and she describes these levels as ranging from interpretations that point to links between current events in the analysis and events from the patient's history, through interpretations that link events in the patient's external life to the patient's often unconscious phantasies about the analyst and the analysis, to interpretations that focus on the use of the analyst and the analytic situation to enact unconscious phantasy configurations, sometimes pulling the analyst into the enactment. Material from four consecutive sessions of an analysis is presented to illustrate how all levels of transference interpretation may be part of a lively and meaningful analysis, but how the level of interpretation may change as the level of understanding deepens within a session and from one session to the next.     

The shame of existing: An extreme form of shame

This paper presents ‘the shame of existing’ as a form of shame that is deeper and more extensive than those customarily encountered. ‘The shame of existing’ is defined as shame about existing as we are and especially at the fact that we are. It is accompanied by merciless and total rejection of the subject's self and by feelings of extreme worthlessness and inferiority coupled with the all‐pervasive conviction that it would be better not to exist. On the basis of clinical material, consideration is given to the specific transference and countertransference aspects of analyses in which the shame of existing constitutes an important part of the patient's pathology. Disturbance of handling and holding by the primary objects right from birth is suggested as the earliest developmental basis of the shame of existing. This disturbance is attributed to hate and rejection of the infant by the primary objects and to the infant's not being touched emotionally and physically and not having its right to exist acknowledged. The paper begins with an introduction to shame as an affect and as a concept in psychoanalytic theory.     

Playing and working through: a neglected analogy

The author proposes an analogy between certain features of playing and aspects of working through. Conceptualizing psychoanalysis as the process whereby unconscious fantasy is uncovered and then subjected to rigorous scrutiny, and building on Freud's (1908) insight that play is the same as fantasy--with the essential difference that fantasy links itself to real objects in play, such as toys and playthings--the author proposes that play can be thought of as not merely symbolic, as a fantasy bearer, so to speak, but as a fantasy tester as well. In the process of working through, some analysands attach their unconscious fantasies not only to a transference object, a primary libidinal object, or a significant loved one, but also to actual props within the analytic setting (a Kleenex box, for example), making the analogy with play even more obvious and palpable.     

Transference,triangles and trajectories

In this article the author addresses the issue of the need to lessen the likelihood of a regressive transference neurosis in short-term therapy. He examines the role that active interpretation of the transference can have in shaping the transference so that it remains at the level of the transference that is ubiquitous. He explores the relationship between such an active interpretative approach and the need for the therapist to be empathic and sensitive to the patient and to allow space for a patient's independent discoveries. The author describes the role of the Central Therapeutic Focus, as a constellation of the Triangles of Insight, in guiding the therapist to select those manifestations of the transference to interpret, and in enabling the therapist to retain a stance that is sensitive and empathic. The Central Therapeutic Focus is contrasted with the concept of the Central Issue, and with the latter's more specific attention to the contribution that it makes to the therapist's communication of their empathic understanding of the patient's difficulties. The nature of the relationship between the therapist and the patient in short-term therapy is explored further and the connections between companionable interaction, ego-relatedness and the matrix of the transference are outlined. The author proceeds to consider the nature of the process of working through in short-term therapy and of the need to attend to the patient's external world as the place in which this can occur. The contribution of the Central Therapeutic Focus in shaping the trajectory through which the patient and therapist attend to the external world is examined. This in turn is linked to the identification of a patient's ordinary solution to their problem as a means of resolving their Dilemma. The article concludes with a case example that illustrates these themes.