Discussion of “Vitalizing Enactment”

In this discussion of Amy Schwartz Cooney’s paper I heartily endorse her use of the ideas of Anne Alvarez, particularly as regards the vitalizing dimension of our clinical work with adults. I link these ideas with the current sea change in psychoanalysis about the need for theories addressing the ground level of contact making. I question the continued reliance on the concept of enactment and propose instead the establishment of a new language for working at this level, drawing on the writings of field theorists, infant–parent research, and child analytic work in the hope of discovering the medium that best captures the imagination and embodied and vital sensibility of our patients. I end by picking up on Cooney’s reference to necrotic zones and their relationship to “death equivalents” and what we may consider the life/death continuum.     

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.     

Difficult Days: The Continuing Evolution of Relational Group Analysis: Discussion of “Taking the Sting Out: Manifesting Aggression and Containing Difficult States in a Relational Group Psychotherapy”

Raufman’s paper is located in the ongoing integration of relational concepts into the world of group analysis. Raufman’s difficult days of therapeutic impasse in her group are regarded as emblematic of the theoretical bind that she and other group analysts find themselves in, caught between older, more classically based theory that inheres in much group therapy and theory and the recent embrace of relational concepts. An alternate reading of the group enactment is offered from the perspective of an unobtrusive relational group analyst with a focus on the conductor’s negative capability and capacity to companion the group’s organic psychological language and idiom in a process of enactive co-narration. It is suggested that when Raufman killed the wasp, the group finally found the vitalizing, enlivening, and companioning object in the leader, that it had been seeking all along.     

Discussion of “Taking the Sting Out: Manifesting Aggression and Containing Difficult States in a Relational Group Psychotherapy”

Ravit Raufman’s paper contributes to the bridging gap between relational approaches and group therapy. It is also important in its recognizing the (group) therapist’s aggression and suggesting how to use it in the service of the group development. In this review I focus on the dynamics of a group of women led by a woman to explain some of the phenomena that Raufman describes in her article, and I add some social unconscious ideas to enrich our understanding of that group.     

“That's Not Analytic”: Theory Pressure and “Chaotic Possibilities” in Analytic Training

Hoping to create my own analytic voice, I experienced complex pressure to conform to the venerated rules of American ego psychology. I could find myself looking over my shoulder, and my training could become saturated with received ideas. Using complex systems theory as a ground, I contrast the constricting pressure to conform that I experienced with three supervisors with the openness that I found with my fourth. I propose that analytic training is a nonlinear, complex developmental process that occurs in a space of “chaotic possibilities” (Glatzer-Levy, 2004)     

Relational Levels of the “Container-Contained” in Group Therapy

The cornerstone of W. R. Bion's theory of individual and group development is that thinking is a primary emotional need, and it matures in the context of social communication. Bion (1970) formulated the essential relationship between thinking and communicating in terms of the container-contained relationship. Bion (1970) described three types of communication, occurring on different levels of development: commensal, symbiotic, and parasitic. These patterns involve normal and pathological variations of the container-contained and call for different expressions of the therapist's subjectivity. In this paper, I describe each of these alterations as they apply to group therapy and to therapeutic activity. I include case examples of how I utilize the conceptual framework in my work.     

“The Most Difficult of all Phenomenological Problems”

I argue in this essay that Edmund Husserl distinguishes three levels within time-consciousness: an absolute time-constituting flow of consciousness, the immanent acts of consciousness the flow constitutes, and the transcendent objects the acts intend. The immediate occasion for this claim is Neal DeRoo’s discussion of Dan Zahavi’s reservations about the notion of an absolute flow and DeRoo’s own efforts to mediate between Zahavi’s view and the position Robert Sokolowski and I have advanced. I argue that the flow and the tripartite distinction it introduces into consciousness is firmly grounded in Husserl’s texts and is philosophically defensible. The absolute flow is distinct but inseparable from what it constitutes. It is intentional in a nonobjectivating way, and accounts for the awareness I have of my individual acts of consciousness and of the unity and continuity of my conscious life. In its absence, consciousness would become an incoherent stream of episodic acts. There is nothing mysterious about the flow. What would be mysterious is consciousness without the flow.     

Unchartered lands in an age of “accountability”

Hallelujah! God Bless America! No one has these prices—Only Daniela High Fashion Dresses. High class merchandise at low low prices. 649 Lexington Avenue, New York, NY 10022. Business card of a Manhattan dress shop. By associating welfare provisions and other (selected) government interventions with socialism/communism and conversely the free enterprise system with loyalty, patriotism, the American Dream, the American way of life, the propagandists are doing no more than manipulating the appropriate Satanic and Sacred symbols. A. Carey,Taking the Risk Out of Democracy. Life, liberty and the pursuit of happiness ... If the spirit of adventure beats within you, the Jeep Cherokee’s 4 liter, 6 cylinder engine and Selec-Trac 4WD are ready and willing to take you where you desire ... Happiness is not difficult to find in a Jeep Cherokee. Advertisement inThe Bulletin magazine. An early version of the paper was delivered at a joint seminar of the China University of Politics and Law, La Trobe University and the University of Melbourne, at La Trobe University, July 1996.     

The “Once and Future” Focus of a Relational Psychoanalysis: Discussion of “Vitalizing Enactment”

In this discussion of Amy Schwartz Cooney’s paper (this issue) I focus on the current interest in relational theorizing on the analyst’s proactive role vis-à-vis her patient, that is, what she actually does for or gives to her patient. I consider the role of the analyst’s own internal “bad” objects in facilitating or inhibiting the therapeutic process. I end with a set of theoretical propositions about the ways in which an intense and deadening shame can lead to dissociation and/or repression of hopeful fantasies about the future.     

Working with “Difficult” Patients: An Interview with Jorge García Badaracco

Jorge García Badaracco's pioneering work is well-known in his native Argentina, but not so much elsewhere. Since he was appointed as Director of a service in the Borda Buenos Aires Neuro-Psychiatric Hospital in 1959, García Badaracco started to make use of all available resources to overcome the many problems that the analysis of "difficult patients" (often psychotic) entails. In later years, he developed his ground-breaking "multifamily groups", that is, therapeutic groups that included patients, their relatives, nurses, members of the staff, and that offered the possibility to work simultaneously, in one single therapeutic intervention, on the individual, familiar, and social dimension of the mind. In this interview with García Badaracco, Francesca Viola Borgogno introduces the reader to this distinguished figure, as well as to some of his most original theoretical and clinical concepts, such as "the maddening object", "the pathological and pathogenic interdependence", "the healthy virtuality", and so on.     

How Is an Analytic Approach to Chinese Philosophy Possible? — An Observation from Perspective of Methodology

How to apply an analytic approach to Chinese philosophy has been a controversial issue in the field of the modern Chinese philosophy. The key to such an application is using an analytical approach. Various forms of analysis are used in modern philosophy. The term “analytic approach” refers to both conceptual and semantic analyses by which to analyze meaning and apply philosophical concepts, so as to interpret a different significance of these philosophical concepts. Beginning with the challenge of the analytic approach as applied to Chinese philosophy, it is necessary to address the line of holism and transcendental argument in terms of philosophical methodology. The former provides us with a framework of analysis of particular problems, while the latter helps us clarify the major difference between a philosophical argument and other arguments for knowledge. Chinese philosophy must greatly emphasize the importance of philosophical methodology, so as to reconstruct the framework of Chinese philosophy as it stands today.     

“Hold Me Tight”: The Generalizability of an Attachment-Based Group Intervention to Chinese Canadian Couples

“Hold Me Tight” (HMT) groups are an adaptation of emotionally focused therapy (EFT) for couples and have emerged out of 30 years of research into the efficacy and process of EFT. The goal of this study was to test the effects of a Chinese-language version of the HMT relationship enrichment program in a sample of Chinese Canadians. Twenty-three men and 23 women (N = 46) in committed couple relationships completed an HMT relationship education program with their partners in Toronto, Ontario, Canada. Results indicated statistically significant improvements in participants' satisfaction with their attachment relationships, in their attachment security, and in their family functioning. The implications of these findings are discussed in light of relevant cross-cultural literature on attachment and couple relationships.