Personal recollections of the revival of psychoanalysis in West Germany during the first post-war decades]

National Socialism destroyed the integrity and substance of Psychoanalysis in Germany for a long time to come. The author was among those responsible for the reintroduction of psychoanalytic knowledge and in the organization of psychoanalytic institutions. In this article she tells about the difficulties in reestablishing psychoanalysis in the new Federal Republic, where it met considerable resistance and obstacles. In particular the author gives credit to the significant contribution of German and Austrian emigrants as well as that of psychoanalysis in Anglosaxon countries, especially the London "Schools" of Anna Freud and Melanie Klein.     

BECOMING RELATED: THE EDUCATION OF A PSYCHOANALYST

The author uses a “professional memoir,” a story about his first experiences in clinical work, to illustrate what he believes to be certain fundamental aspects of an analytic attitude. Taking place in a psychiatric hospital, it is meant to highlight the central place of intuition, emotional receptivity, empathy, relatedness—and their inherent dangers—in engaging therapeutically with patients' emotional disturbances. The author postulates that these and related aspects of clinical psychoanalysis are not sufficiently emphasized in psychoanalytic training and are often eclipsed by idealizations of psychoanalytic theories and their derivative techniques, third‐party demands for evidence‐based data, preoccupations with neurobiological correlates of experience, etc. Despite the clinical fact that psychoanalysis can be extraordinarily helpful to patients, he questions whether clinical psychoanalysis is rightly regarded as a “treatment.”     

A Contemporary Notion of Time: Fragments of a Case from Rio de Janeiro

This paper presents vignettes of a case from the city of Rio de Janeiro in which temporality appears as a fundamental issue. Severe difficulties in validating the past and integrating past, present and future reveal pertinent questions on time and the ideal function in the contemporary world. The author underlines the relevance of such questioning for the practice of psychoanalysis today.     

Discussion of Dominique Scarfone’s Paper, “On ‘That Is Not Psychoanalysis’: Ethics as the Main Tool for Psychoanalytic Knowledge and Discussion”: Terminable and Interminable Discussion

When we ask ourselves if psychoanalysis is a science and what type of science it is, we raise many questions related to the notion of faithfulness. For instance, we might ask what it means to be faithful to a text, to the essence of an author’s writings, or to his or her creative power. If being a psychoanalyst means, at the very least, being able to translate the other’s thoughts, one of the difficulties of this task lies in what we call the complexity of translation. Analysts translate, interpret, interfere with the thoughts of the other in order to open up new paths, to offer themselves as a projection screen, or to try to create a link between two subjects so as to make room for the present, which is sometimes erased by history. To elucidate some of these issues, Scarfone (this issue) focuses on a discussion on the ethics of the analyst and of psychoanalysis     

The Psychoanalysis of Narcissism and the Inevitability of “Postmodern” Psychoanalysis

In my exploration of postmodern psychoanalysis, I take as my starting point the complex issue of narcissism as developed by Freud. After pointing out some of the theoretical and clinical difficulties and complexities that arise in the analysis of narcissism, I discuss the diversity of the models and interpretations that then become possible; plurality in psychoanalysis is an inevitable consequence of this. The analysis of narcissism thus opens up many questions that lead me to explore some of the answers that both our forebears and present-day psychoanalysts have suggested.     

Aaron T. Beck's drawings and the psychoanalytic origin story of cognitive therapy

In this essay the author challenges the standard origin story of cognitive therapy, namely, that its founder Aaron T. Beck broke with psychoanalysis to pursue a more pragmatic, parsimonious, and experimentalist cognitive model. It is true that Beck broke with psychoanalysis in large measure as a result of his experimental disconfirmation of key psychoanalytic ideas. His new school of cognitive therapy brought the experimental ethos into every corner of psychological life, extending outward into the largest multisite randomized controlled studies of psychotherapy ever attempted and inward into the deepest recesses of our private worlds. But newly discovered hand-sketched drawings from 1964 of the schema, a conceptual centerpiece of cognitive therapy, as well as unpublished personal correspondence show that Beck continued to think psychoanalytically even after he broke with psychoanalysis. The drawings urge us to consider an origin story much more complex than the one of inherited tradition. This new, multifaceted origin story of cognitive therapy reaches beyond sectarian disagreements and speaks to a broader understanding of the theoretical underpinnings of cognitive therapy.     

Gender and Transference

Despite an early interest, Freud explicitly rejected philosophy, because of its “speculative” character. He struggled with balancing the intellectual appeal of philosophy with the certainty he hoped to find in positivist science. Putting aside the scientific status of Freud's work, the author re-examines Freud's attitude towards philosophy. Failing to recognize the assumptions of his investigations, Freud segregated psychoanalysis from philosophy on the charge that philosophers equated mind with consciousness, putatively propounded unfounded speculations, and assumed false conclusions about comprehensiveness. However, Freud never completely abandoned his initial philosophical proclivities. His own contributions to cultural history, social philosophy, notions of personal identity, and the humanistic thrust of psychoanalysis, demonstrate that he continued to address his earliest interests in philosophical questions. The author elucidates the philosophical complexity of psychoanalysis and concludes that a reconsideration of Freud's self-appraisal of his intellectual commitments is warranted.     

The enduring presence of Heinz Kohut: empathy and its vicissitudes

This paper expands upon and further develops the centrality of empathy in psychoanalysis as offered by Heinz Kohut. Using clinical examples, it differentiates sustained empathy as the distinctive component of psychoanalysis, and it demonstrates some of the difficulties in determining the boundaries of empathy in the practice of psychoanalysis. A further distinction is from mind reading, a purely cognitive exercise, as is intuition (Carruthers 2009). To pursue a psychoanalytic perception of empathy one must confront its limitations and go beyond the somewhat simplistic claim of its unquestioned therapeutic effect. Empathy is more than a cognitive act, and as sustained over time it can be difficult to achieve, can be misunderstood, and can at times have no therapeutic effect.     

Mental health – a normal state?

ABSTRACT

How can we conceptualize mental health; what is the relation between mental health and normality; and what has psychoanalysis to say about these questions? After a short resume of the views concerning normality and melancholia in the last centuries, the author turns to Freud and Bion. For Freud, mental health at best seems to be a relatively mild neurotic state, and perfect mental health is an unattainable ideal. Bion underlines the dynamic nature of the concept; mental health comprehended as a process. Problems connected to the individual’s subjective view of his or her mental health are considered, and some consequences that the questions under discussion have for psychoanalytic treatment are discussed. The author concludes with a reflection on the complex relation between mental health and normality.     

How Françoise Dolto links Lacanian psychoanalysis with the Christian Gospels

This article introduces to an English-speaking audience of pastoral therapists, the writings of the French Lacanian psychoanalyst, Fran?oise Dolto (1908-1988) on the links she discovered between the most profound question raised by Lacanian psychoanalysis in its dynamics effects and the questions raised by the Christian Gospels. The author summarizes the main points of Dolto's Lacanian thought and where she departed from Lacan in her interpretation of the unconscious ethic of desire. Using Dolto's three writings on Lacanian psychoanalysis and the Bible, as well as material from her published clinical studies, the author illustrates Dolto's approach to the Bible, the parable of the Good Samaritan, and her application of the dialectical principles of desire in three case studies.     

The role and importance of interpretation in the talking cure

Starting with an exploration of how the concept of interpretation in analytical treatment has evolved, the author goes on to discuss the role and importance of interpretation in the changes that psychoanalysis brings about. Although interpretation is looked upon as the key element in psychoanalytic activity, the fact that it is subsumed within the transference raises questions as to its influence in the analytical domain. After discussing the foundations of interpretation with respect to the theory of psychoanalytic treatment and examining Strachey’s views on this, the author defines the conditions and constraints surrounding interpretation and preparatory interventions in order to outline the essential nature of the interpretative process as seen against the wider background of the analyst’s activity as manifested through speech. This leads to a discussion of the relative influence of insight and suggestion in bringing about therapeutic change. The author draws the conclusion that interpretation works as a metaphor in lifting repression.     

Is the Oedipus complex still the cornerstone of psychoanalysis? Three obstacles to answering the question

Current controversies about the centrality of the Oedipus complex in psychoanalysis are difficult to resolve unless we address three obstacles in the way of rational examination. The first is that the Oedipus complex, Freud's "shibboleth" of psychoanalysis, is politically controversial. Second is the great difficulty in agreeing upon the definition and boundaries of the Oedipus complex, especially the necessary complexities introduced with the negative Oedipus complex, female sexuality, the nature of the preoedipal, and counteroedipal fantasies and actions. The third obstacle involves basic questions of psychoanalytic epistemology: our criteria for evidence to prove or disprove any particular proposition. I conclude that the awareness of these difficulties signifies a certain maturation in our thinking and that the complexity introduced by these obstacles can in time provide the groundwork for a set of formulations that is richer and closer to the complexities and ambiguities of the clinical situation.     

The rooting of the mind in the body: new links between attachment theory and psychoanalytic thought

The relationship between psychoanalysis and attachment theory is complex indeed. A brief review of the psychoanalytic literature as it concerns attachment theory and research, and of the attachment literature as it pertains to psychoanalytic ideas, demonstrates an increasing interest in attachment theory within psychoanalysis. Some of the difficulties that attachment theory faces in relation to psychoanalytic ideas are traced to its links to the now dated cognitive science of the 1960s and 1970s. Today, however, a second-generation cognitive neuroscience seeks neurobiologically plausible accounts in which links with brain and body are seen as shaping mind and consciousness, which increasingly are seen as "embodied", as emerging from or serving the needs of a physical being located in a specific time, place, and social context. This idea has also been at the core of much psychoanalytic thinking, which has historically affirmed the rootedness of symbolic thought in sensory, emotional, and enacted experience with objects. Now neurobiological advances supporting the concept of embodied cognition offer an opportunity to forge powerful links between the hitherto separate domains of attachment theory and psychoanalysis. Speculations about the nature of language are presented that emphasize the origin of internal working models (and of representations in general) in early sensorimotor and emotional experiences with a caregiver. It is argued that language and symbolic thought may be phylogenetically and ontogenetically embodied, built on a foundation of gestures and actions, and are thus profoundly influenced by the experience of early physical interaction with the primary object. Finally, the clinical and research implications of these ideas are discussed.     

Should Analytic Patients Be “Created”? Reflections on Arnold Rothstein's Psychoanalytic Technique and the Creation of Analytic Patients

Abstract

The five points of Arnold Rothstein's interesting monograph are each discussed and critiqued in this article. In particular, Rothstein is commended for his commitment to expanding the availability of an intensive, psychoanalytic treatment for a broad spectrum of patients who may often be very difficult to engage. Rothstein also accounts for difficulties in engaging analytic patients from obstacles in the attitudes of analysts such as a latent lack of conviction about the efficacy of psychoanalysis and from overly restricted stereotypes about the spectrum of appropriate patients. He recommends a flexibility of technique and accommodation to the needs of patients with which this author agrees.

Others of Rothstein's observations and recommendations seem more problematic. Specifically, issue is taken with his suggestion that analysts attempt to provide a trial of psychoanalysis for all nonpsychotic patients and to begin on a less intensive basis only within the frame or interpreting prospective patients' objections as a resistance. This author also disagrees with Rothstein's interpretation that patients resist the offer of a psychoanalysis out of a self-defeating masochistic enactment that needs interpretation. Case examples are provided that belie this overly generalized interpretation. Additionally, this author critiques the metapsychological assumptions underlying this particular mode of interpreting a reluctance to begin psychoanalysis.

While commending Rothstein's therapeutic goals and recommended flexibility of technique, this author would also stress a fundamental concern about the patient's conscious and unconscious experience of the analyst's agenda. In other words, rather than working toward the analyst's goal of establishing a psychoanalytic situation, emphasis is placed instead on the basic right of patients to proceed in a manner that respects their sovereignty over how intensively they may choose to work. Therefore, in contradistinction to Rothstein's suggestions, it is recommended that the analyst's primary focus should be to provide an availability to work on the patient's conflicts and developmental needs with a respect for the timing of their emergence and expression within a treatment frame that invites but does not prematurely elicit and confront. By proceeding in this way a patient's salient dynamics will be allowed to emerge “organically” instead of being hastened prematurely in reaction to the analyst's insistence on the Tightness of a particular schedule or manner of proceeding. This author believes that with this approach more, rather than fewer, patients will be able to accept the recommendation of an intensive psychoanalytic treatment.     

On the fate of psychoanalysis and political theory

The author explores the present structure of the relationship between psychoanalysis and political theory, finding that the two often attempt to integrate each other's findings as mere resources within the pursuit of fundamentally self-determined projects. This radically misconstrues the force and meaning of the insights upon which they draw. Especially when psychoanalytic interpretations of collective subjects (nations, regions, etc.) occur, the relationship between psychoanalysis and political theory may not be appropriately mediated, promoting suspiciousness about the interpretive and therapeutic efficacy of such nonclinical "interventions." The author proposes an alternative paradigm for a new working relationship between psychoanalysis and political theory.     

High frequency long-term analysis and psychoanalytic practice. Utopia and reality

On the basis of the prognostic study of psychotherapeutic treatment in the Federal Republic and of the evaluation of more than 1000 applications for insurance benefits submitted in the years from 1973 to 1983, it is suggested that high-frequency long-term analysis is the exception rather than the rule and that it is carried on almost exclusively by a small group of "privileged" therapists. The author asks what this implies for the definition of psychoanalysis and for daily treatment practice. Are therapists being trained for a kind of treatment that they will rarely or never practice? The author urges resumption of the discussion of theory and technique of psychoanalysis in which these questions will be considered.     

The manifest dream in psychoanalysis: a clarification

Controversies about the value of the manifest dream in psychoanalysis are usually a matter of semantics. The author concludes that two clinically meaningful questions about the manifest dream can be asked: Is the patient's report of a dream useful in formulating an interpretation if no formal associations to the dream elements are given? Inasmuch as such reports always include some kind of associations, and the analyst always possesses considerable knowledge about the patient, the answer to this question would seem to be "Yes, at least at times." In what ways can the manifest dream contribute to our understanding of the dream and the dreamer? Both the literature and clinical experience indicate that there are many ways; these are summarized in an appendix. One approach, the direct decoding of manifest dream elements, is discussed in some detail. Several examples of the undisguised appearance of memories of childhood traumatic experiences in the manifest dream are presented.     

Psychoanalysis and the Catholic Church in Italy: the role of Father Agostino Gemelli, 1925-1953

Agostino Gemelli, a Catholic priest, psychiatrist, administrator, and educator, was an important figure in the early history of psychoanalysis in Italy. He was one of the few establishment figures to grapple with Freud's ideas in Italy during the first half of the twentieth century, a period during which Italy, compared to the rest of Europe and to the United States, was relatively impermeable to psychoanalysis. One of the factors that contributed to this was the opposition of the powerful Catholic Church, which identified in psychoanalysis a challenge to its authority. The author argues that Father Gemelli's shifting positions about psychoanalysis between 1925 and 1953 reflected the exigencies of his historical circumstances. Gemelli was able to identify in psychoanalysis an integrated view of the human condition in stark opposition to the brutal reductionism of psychiatry in Italy at that time, but also encountered in it elements intolerable to the Church. Examining specifically what it is that Gemelli could accept of psychoanalysis, and what needed to be rejected, between 1925 and 1953, illustrates the particular challenge posed by psychoanalysis to Catholicism in Italy.     

Janine Chasseguet-Smirgel and psychosexuality - a reminder

Janine Chasseguet-Smirgel, who would have turned 90 this year, had a passion for truth that placed her work at the very heart of psychoanalysis. Never leaving the field of Freudian analysis she explored the inevitable difficulties, due to our premature birth, to become moral subjects. Psychoanalysis was to her, as it was to Freud, a psychology of conflict. She was suspicious of seemingly optimistic views which saw conflict as created between the potentially free subject and one repressive external system or another. Freedom is always limited in psychoanalysis. In an attempt to follow the line of thought in her vast production the article touches upon her critique of Freud’s so called phallic monism, the significance of both parents’place in the psyche, the question of “Falsehood”, perversion as a dimension of the human psyche, and her concerned view on the situation of Western thought today. The author suggests that we might benefit from her radical Freudian stance in a time when the view on truth is undergoing many unfathomable transformations. Perhaps Chasseguet-Smirgels thought can also be an important reminder about the foundations of our work; not just sexuality, not just mental acts but their specific relationship to each other     

Infant observation: A range of questions and challenges for contemporary psychoanalysis1

The author attempts to integrate several perspectives within the field of infant observation that reflect the analyst's personal experience as a clinician, as a professor at the analytic institute and as a researcher in the field of psychoanalysis. Can infant observation contribute to analytic technique, theory and training? If so, what would be the nature of such contribution? To answer these questions, the author reviews the literature on infant observation from Freud to the present, highlighting Latin American contributions to this subject. She makes reference to the role of technological innovations, which have allowed videotaping, repeated observations, temporal segmentation and computerized programs, thus giving rise to microanalytic research. This discussion prompts the question about the contributions made by systematic research to clinical practice. To tackle this question, the author presents both a clinical vignette taken from her personal experience, and the current debate on this subject as it appears in the work of Daniel Stern and André Green. Finally, she presents some conclusions that are part of an ongoing debate in the psychoanalytic field.