Psychoanalytic observation

The recent focus on empathy as the essential activity in psychoanalytic data gathering has underemphasized the complexity of psychoanalytic observation and has failed to identify what truly makes it unique among modes of psychological investigation. It is a process that includes introspection and empathy. However, it also includes the analyst's observation of the patient's behavior, and particularly verbal behavior, in a way that is not necessarily empathic. The psychoanalytic use of introspection and behavioral observation together, as they are modified by the analysand's free association and the analyst's evenly hovering attention, provides a unique method of data gathering. The transient, mutually related regressions of analyst and analysand which partly constitute the analyzing instrument modify the field of observation available to both, providing better access to derivatives of the analysand's unconscious mental functioning. This more complex concept of psychoanalytic observation, as opposed to that in which empathy is predominant, has important implications for psychoanalytic training, clinical work, and theory.     

Psychoanalytic process

Differing concepts of psychoanalytic process and views of its "locale" are related to how essential the interactivity of the analyst is judged to be. Scientific scrutiny of clinical psychoanalysis requires that the interactive nature of the process be recognized. In this endeavor the concept of "process model" is helpful, as is the view of psychoanalysis as a form of treatment in which therapeutic process and therapeutic agent are distinguished.     

Psychoanalytic Companioning

In this paper I offer an integration of object relations and relational conceptions of clinical interaction and suggest a register of psychoanalytic companioning. I suggest that when working with patients and states where there is no self-other definition and therefore no mutuality, the path to healing and growth is via companioning the patient into the darker, more regressed and unformed states of illusion and merger rather than via the promotion of separateness and relatedness, which, I propose, will accrue from within the companioning register. The analyst works from within an unobtrusive relational position. I offer a case example of my work in this register and suggest that this offers a different register of the use of the analyst’s subjectivity: one that is receptive, “cooperative” (Trevarthen) and responsive to the patient’s internal world and objects, rather than analytic and knowing. I consider the dimensions of intersubjectivity that cohere with the dimensions and levels of the patient’s mentalization as outlined by Leciurs and Bouchard (1997).     

My Psychoanalytic Journey

I am grateful to the editors of Psychoanalytic Inquiry for inviting me to participate in this retrospective issue on our collective psychoanalytic journeys. Life proceeds, both personally and professionally, in such a dense rush that this has provided a precious opportunity for me to take a longer view. Histories of persons, of nations, or of disciplines can be told in many different ways. The most compelling narrative of my own psychoanalytic history, from my current vantage point, is one with not too many surprises but with continuity and progressive deepening and enrichment.     

My Psychoanalytic Journey

In this article I describe the evolution of my psychoanalytic thought and my current perspective of psychoanalysis, after almost a half century of professional practice. For the most part, three ideas have guided this evolution: (1) considering the patient’s mind as the major source of knowledge; (2) my firm belief that the patient–analyst dialogue, taken from the Gadamerian point of view, is the best way to have access to the patient’s mind and also to that of the analyst himself; and (3) the notion that the mind constitutes an open, dynamic, and nonlinear system in constant interaction with the environment that surrounds it. In my writings, I have tried to show that the therapeutic action in the psychoanalytic process is formed by the therapist–patient interaction. I also propose that psychoanalysis must endeavor to be a social therapy, even as it treats individuals, and go beyond what is purely instinctual so as to emphasize what is particular to human beings and sets us apart from the other animal species.     

Psychoanalytic Opus Nigrum

This paper presents my developmental experience in becoming an analyst as the daughter of one of the first psychoanalysts in a growing city in northern Mexico. Using historical and social context, I will explain my training conditions. In medieval times, maltreatment was impossible to avoid, and competence was a personal quest. My psychoanalytic education has been widened in scope by research that afforded me the opportunity to free my “psychoanalytic spirit.” Acceptance of reality and openness to new experiences are crucial for transformation. Answers can be found by considering new, unprecedented possibilities and striving for excellence through curiosity-driven research.     

Psychoanalytic controversies contextualized

Psychoanalytic disagreements are famously heated, polarized, and prolonged. These controversies are often the reflection of a shared agreement by the participants to engage in debate at an abstract level far removed from the clinical context in which the disagreement first arose. As a specimen example of such disputes, a case report by Patrick Casement is examined, together with a series of polemical discussions it inspired concerning physical contact suddenly demanded by an analysand in session. Over two dozen authors were almost evenly divided on whether to agree with Casement's technical conclusions, but showed a disquieting indifference to the detailed information available in his report regarding how this clinical crisis developed. The substantive merits of the contending arguments are not at issue; rather, the point is to demonstrate the crucial need to refine a methodology of contextualization to clarify inferential assumptions in clinical discussions. Premature truth claims might then give way to a more rational comparison of the clinical sources of divergent opinions. The term contextual horizon is introduced to facilitate an understanding of how the psychoanalyst makes inferences from the patient's associations.     

Psychoanalytic transformations1

The author describes how Bion took Freud's conception of dreams as a form of thought and used it as the basis of his theory of transformations. Bion developed an expanded theory of ‘dream thought’, understood as a process of selection and transformation of sensory and emotional experiences. In this theory, the work of analysis is in turn conceived as a process not only of deciphering symbols, of revealing already existing unconscious meanings, but also of symbol production‐of a process for generating thoughts and conferring meaning on experiences that have never been conscious and never been repressed because they have never been ‘thought’. Analysis, in its specific operational sense, becomes a system of transformation whereby unconscious somatopsychic processes acquire the conditions for representability and become capable of translation into thoughts, words and interpretations. The rules of transformation applied by the patient in his representations and those applied by the analyst in his interpretations have the same importance for the analytic process as those described by Freud for the process of dreaming. The author discusses the broad categories of transformation adduced by Bion (rigid motion, projective, and in hallucinosis) and introduces some further distinctions within them.     

Psychoanalytic action explanation

Psychoanalysis is concerned with neurotic behaviour that counts as an action if one takes into account “repressed” mental states. Freud's paradigmatic examples are a challenge for philosophical theories of action explanation. The main problem is that such symptomatic behaviour is, in a characteristic way, irrational. In line with standard interpretations, I will recap that psychoanalytic action explanation is not in accordance with Davidson's classical reason-explanation model, and I will recall that Freud's unconsciousness is not a second mind with its own rationality but that it is non-propositional in character. However, I then will argue that this characterization is not discriminating enough to explain the dynamical unconscious and overlooks the crucial role of “counter-cathexis”. With counter-cathexis the relevant desire turns out to be a complex with two inseparable aspects (“double-aspect view”), so that the causing belief–desire pair is still part of the space of reasons, although it cannot rationalize the behaviour. Psychoanalytic action explanation is hence still Davidsonian, albeit in a modified way.