ANALYTIC MIND USE AND INTERPSYCHIC COMMUNICATION: DRIVING FORCE IN ANALYTIC TECHNIQUE,PATHWAY TO UNCONSCIOUS MENTAL LIFE

Developed from established psychoanalytic knowledge among different psychoanalytic cultures concerning unconscious interpsychic communication, analysts' use of their receptive mental experience—their analytic mind use, including the somatic, unconscious, and less accessible derivatives—represents a significant investigative road to patients' unconscious mental life, particularly with poorly symbolized mental states. The author expands upon this tradition, exploring what happens when patients unconsciously experience and identify with the analyst's psychic functioning. The technical implications of the analyst's “instrument” are described, including the analyst's ego regression, creation of inner space, taking mind as object, bearing uncertainty and intense affect, and self‐analysis. Brief case vignettes illustrate the structure and obstacles to this work.     

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.     

The Explicit and Implicit Domains in Psychoanalytic Change

New research findings of the development and organization of the mind, brain, and behavior bolster the ongoing relational- or intersubjective-field paradigmatic revision of psychoanalytic theory. A multisystems view of learning, memory, and knowledge provide us with a more complex picture of information processing that has fundamental implications for a psychoanalytic theory of therapeutic action.

If the implicit and explicit learning/memory systems are viewed as parallel processes, not easily translatable from one to the other, then new implicit relational experience carries considerably more power as compared to explicit/declarative processing in changing and establishing new implicit mental models. When these cognitive processing systems are viewed as more closely interconnected with a developmental emphasis on connecting them through language, then exploratory/interpretive work becomes more central. REM, dream, infant, and cognitive research evidence suggests that imagistic symbolic capacity exists at birth. Learning and remembering using imagistic symbolic processing could suggest a more easily translatable connection with later developed verbal symbolic processing and a closer, although varied, interconnection between implicit and explicit (symbolic) memory systems.

Explicit attitudes are more directly modifiable through an explicit/declarative focus. Implicit mental models, it is proposed, are variably modifiable through two different change processes: (1) accommodation or transformation of expectancies through new implicit procedural experience (not requiring explicit focus) and (2) diminished activation and increased capacity to deactivate implicit mental models through explicit/declarative processing and the establishment of contrasting implicit models through new implicit procedural experience.     

Affect as a marker of the psychic surface

The author reviews the literature on identifying affect as a technical tool, on the nature of affect in general, and on the relationship between affect and repression. How affect comes to light in the clinical setting is discussed, as well as how it and defenses against it can be worked with to deepen the psychoanalytic process. Two extended clinical examples and many shorter vignettes illustrate the usefulness of following the patient's affect in the psychoanalytic setting.     

The explicit and implicit dance in psychoanalytic change

How the implicit/non-declarative and explicit/declarative cognitive domains interact is centrally important in the consideration of effecting change within the psychoanalytic arena. Stern et al. (1998) declare that long-lasting change occurs in the domain of implicit relational knowledge. In the view of this author, the implicit and explicit domains are intricately intertwined in an interactive dance within a psychoanalytic process. The author views that a spirit of inquiry (Lichtenberg, Lachmann & Fosshage 2002) serves as the foundation of the psychoanalytic process. Analyst and patient strive to explore, understand and communicate and, thereby, create a 'spirit' of interaction that contributes, through gradual incremental learning, to new implicit relational knowledge. This spirit, as part of the implicit relational interaction, is a cornerstone of the analytic relationship. The 'inquiry' more directly brings explicit/declarative processing to the foreground in the joint attempt to explore and understand. The spirit of inquiry in the psychoanalytic arena highlights both the autobiographical scenarios of the explicit memory system and the mental models of the implicit memory system as each contributes to a sense of self, other, and self with other. This process facilitates the extrication and suspension of the old models, so that new models based on current relational experience can be gradually integrated into both memory systems for lasting change.     

From psychic holes to psychic representations

Abstract

In this essay, I will explore the term “psychic hole,” and compare it to similar terms from the world of astrophysics and terms used in the psychoanalytic literature. I will then present my own conception of the “psychic hole” in cases of Holocaust survivors' offspring. I will explain how this “hole” is created, and describe a particular aspect of the “psychic hole” that is unique to Holocaust survivors' offspring, namely the enactments (termed “concretization” by Bergman) generated by the negated traumatic themes that reside in it. I will illustrate these enactments using clinical material taken from case studies of Holocaust survivors' offspring that I have previously published. The clinical vignettes reveal the transgenerational impact of the memory hole resulting from negation of survivor parents on the lives of their offspring, up to the third generation. They also show the painful journey from enactments to psychic representations, a journey which exposes the traumatic events that have been denied or repressed, and facilitates the work of mourning and the eventual achievement of a better integrated self. Finally, I will offer technical suggestions for analysts to help patients transform psychic holes into psychic representations.     

Tacit assumptions,countertransference and psychoanalytic technique. Part two: The influence of countertransference on theory and technique

In this article, the author examines bodily symptoms attributed to psychic mediating factors in the light of a psychoanalytic model of affect and sym- bolization. He uses clinical material from a consultation-liaison setting and a psychoanalytic treatment to illustrate how the model might help to understand different bodily symptoms as manifestations of different degrees of failure in the psychic elaboration of affect. On a more personal note, this could be seen as an attempt to understand, using a newly acquired conceptual tool, what went on in his 20 years of experience in the general hospital psychiatry setting.     

Introduction: A Systems View

Our goal in this series of four papers is a further refinement of a theory of interaction for psychoanalysis, with a specific focus on the concept of intersubjectivity. Psychoanalysis has addressed the concept of intersubjectivity primarily in the verbal/explicit mode. In contrast, infant research has addressed the concept of intersubjectivity in the nonverbal/implicit mode of action sequences, or procedural knowledge. We propose that an integration of explicit/linguistic with implicit/nonverbal theories of intersubjectivity is essential to a deeper understanding of therapeutic action in psychoanalysis today. To shed light on an implicit/nonverbal dimension of intersubjectivity in psychoanalysis, we include concepts from adult psychoanalysis, infant research, developmental systems theories, and nonverbal communication, particularly the distinction between implicit processing out of awareness and explicit processing at the declarative/verbal level. We conclude with an adult psychoanalytic case illustrating the integration of implicit/nonverbal forms of intersubjectivity into adult treatment.     

Omnipotence in the transference and in the countertransference

The concept of omnipotence refers to a primitive fantasy, a mechanism of defense, and a pathological psychic structure. Omnipotence and its derivative defensive operation, omnipotent control, are highly prevalent in borderline personality organization. Three clinical vignettes illustrate these mechanisms in the treatment of patients with borderline, narcissistic, and obsessive personality disorders, respectively. These vignettes illustrate the transference developments when omnipotence and omnipotence control are dominant, and the therapeutic approach to these conditions.     

Analysts' observing-participation with theory

The author summarizes some of the literature's critiques of psychoanalytic theory, which have noted its constrictive quality and failure to take into account the vicissitudes of treatment within each analytic dyad. Such postmodern reactions have given rise to a countertheoretical trend toward psychoanalytic pluralism, leading the author to suggest that a single, standard psychoanalytic technique no longer exists. The interpersonal tradition, which tends to prioritize praxis over theory, is discussed in the light of its emphasis on an intersubjective model of participant-observation, and two clinical vignettes are presented to illustrate the author's way of utilizing this model.     

The Right Brain Implicit Self Lies at the Core of Psychoanalysis

In this contribution I expand my continuing work on the centrality of right brain structures and unconscious processes from the neuropsychoanalytic perspective of regulation theory, an overarching model of the development, psychopathogenesis, and treatment of the implicit self. In an introduction I highlight the essential role of not only implicit cognition but implicit affect, communication, and regulation in current relational psychoanalytic models. I then briefly discuss recent developmental and neurobiological studies of implicit processes in early development and psychopathogenesis. In the bulk of this work I explore the essential role of implicit affective processes in psychotherapeutic change processes. I focus particularly on the expression of right brain unconscious mechanisms in affect-laden enactments, and on the therapist's moment-to-moment navigation through these heightened affective moments by not left brain explicit secondary process cognition but right brain implicit primary process affectively driven clinical intuition. Direct access to these right brain implicit processes by both patient and therapist is central to effective treatment.     

The questions and curiosity of the psychoanalyst

Questions the analyst asks of the patient are a powerful but neglected aspect of the theory of psychoanalytic technique. Their importance resides in their dynamic impact on the psychic equilibrium of the patient because of their ability to destabilize existing compromise formations. A clinical vignette illustrates the view that the linguistic shift from other modes of discourse to the spoken question heralds a less visible parallel shift in the psychic equilibrium of either the psychoanalyst or patient. There is no more and no less complexity to questions than to any other communication by either analyst or patient. For that reason there can be no systematic classification of questions in the clinical psychoanalytic situation, just as there can be no definitive taxonomy of psychoanalytic discourse. It makes no sense to reduce the enormous diversity and range of all the questions the analyst asks to the simple dichotomy of good or bad for the analysis. Questions are the emblem of the analyst's mode of inquiry; they can further the development of self-observation, which is such an important concomitant, cause, and consequence of structural change.     

A matter of time: actual time and the production of the past

In psychoanalytic theory, space metaphors are frequently used to describe the psychic apparatus. As for time, it is traditionally invoked under the heading of timelessness of the unconscious, more aptly described as the resistance of the repressed to wearing away with time. This paper examines how the insertion of time into psychic events and structural differentiation form a single process. After looking into the parallelism between phenomenological and psychoanalytic views of time and differentiation, the author draws a distinction between two time categories: chronological versus actual. A clinical example is presented.     

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.     

Clinical applications of Matte Blanco's thinking

Ignacio Matte Blanco (1908–1995) left very few specific indications about the applications of his theoretical notions to his interpretative style. The author shows how he uses Matte Blanco to formulate some of his own interpretations. The first part of the paper uses clinical vignettes to illustrate some of Matte‐Blanco's concepts. Their theoretical vocabulary is thus made explicit. Then two psychoanalytic sessions are discussed at greater length, together with one from a therapy, so that the use of Matte‐Blanco's notions can be seen clearly, allowing for a fresh perspective on areas of psychoanalytic theory, particularly dreams, psychopathology viewed according to the proportions of asymmetrical and symmetrical functioning in the patient's bi‐logical mental system, the multidimensionality of the unconscious, the structural unconscious, the emotion‐thought relationship, projective identification, resistance, and negative therapeutic reaction. The practical consequences of all this are elaborated, particularly the ensuing possibility of ‘thinking with the patient' in the session. This enables the patient to introject a form of mental functioning in which the asymmetrical mode is not invaded by the symmetric mode (a parallel can be seen here with the Bionian concept of dialogue between the psychotic and non‐psychotic parts of the mind).     

Pentheus rather than Oedipus: On perversion,survival and analytic ‘presencing’1

Following an introductory review of the main developments in the psychoanalytic thinking on perversion, the author focuses on her own understanding of perversion and its treatment, based on the psychoanalytic treatment of patients with severe sexual perversions. This paper uses the term ‘autotomy’ (borrowed from the fi eld of biology) to describe perversion formation as an ‘autotomous’ defence solution involving massive dissociative splitting in the service of psychic survival within a violent, traumatic early childhood situation; thus, a compulsively enacted ‘desire for ritualised trauma’ ensues. The specifi c nature of the perverse scenario embodies the specifi c experiential core quality of the traumatic situation. It is an actual repetition in the present of the imprint of a past destructive experience which is pre‐arranged and stage‐managed; it thus encounters haunting scenes of dread or psychic annihilation while, at the same time, controlling, sanitising and disavowing them. Hence, the world of severe perversion is no longer oedipal, but rather the world of Pentheus, Euripides's most tragic hero‐a world dominated by a mixture of a mother's madness, devourment, destruction and rituals of desire. According to this view, the (diffi cult) psychoanalytic treatment of perversion focuses on patient‐analyst interconnectedness‐brought about by the analyst's ‘givenness to being present’ or ‘presencing’‐at a deep, primary level of contact and impact (the emphasis being on the ontological dimension of experience). This evolving therapeutic entity creates and actualises a new, alternative experiential‐emotional reality within the pervert's alienated world, eventually generating a change in the perverse essence. The author illustrate this approach with three clinical vignettes.     

Conflict in psychoanalysis and in life

Abstract

Unconscious conflicts are at the center of Freudian psychoanalytic inquiry, in the psychoanalytic situation as well as in the theory of personality and pathogenesis. The core dynamic formulation, intrapsychic conflict resulting in new psychic formation, is addressed in the paper in the following steps.

First, the development of the concept of conflict throughout the history of Freudian psychoanalysis is reviewed. Next, the analytic and synthetic aspects of conflict theory are explored and the role of conflict in the development of personality organization and pathogenesis is clarified. Then, the contemporary extensions and elaborations of structural theory are presented.

To illustrate analysis focused on conflict, clinical material covering the phases of psychoanalytic process is highlighted. From the beginning stage of analyzing the patient's initial diffuse state of indifference and “weirdness”, analysis proceeds to address primary and secondary symptoms of impotence and exhibitionism and underlying passive-phallic personality organization with conflict around aggression. This leads to the patient's sense of mastery over previously enslaving and “immobilizing” internal turmoil.     

Conflict in relational treatments

Various features of relational perspectives on conflict are outlined. Points of contact and difference between relational and modern conflict theory are discussed. Five approaches to considering conflict are examined: countertransference conflict as the site of interfaces between the social and the intrapsychic; conflict within the register of speech; conflict within a theory of multiple identifications; conflict as the site of psychic change; and conflict in the context of intersubjectivity. Clinical vignettes are introduced to illustrate the scope and function of conflict within one relational perspective.     

Childhood and Trauma

In this paper, I follow the evolution of the concept of trauma within psychoanalytic theory, and some of the effects of this evolution. Starting out from the point where Freud gives up the theory of trauma as the cause of neurosis in 1897, and the alleged reasons for such a change, I analyze the theoretical and clinical consequences of this change within psychoanalysis. I proceed to develop Ferenczi's ideas on trauma, their relevance to present-day psychoanalytic theorizing and practice, as well as for the understanding of the psychic processes in children, tracing the development of some of these ideas in contemporary psychoanalytic thinking.