Time and the psychoanalytic situation

Implicitly or explicitly, time dominates the psychoanalytic situation. The precision, consistency of duration, and regularity of analytic sessions enhance the patient's ego boundaries, counteracting the regressive effects of timelessness induced by free association. The extended overall duration of psychoanalysis and the high frequency of sessions favor the development of transference neurosis. The interpretation of the transference in the here and now of the analytic situation illuminates the past, and as a result, the patient's self-image and that of the world become better integrated. The sense of time in the analytic situation for both patient and analyst varies along with the vicissitudes of transference and countertransference.     

Losing a father all over again: the termination of an analysis of an adolescent boy suffering from father loss

Criteria for beginning and conducting the termination phase of psychoanalysis have provoked debate and confusion from the early days of psychoanalysis. Gabbard (2009) has recently pointed to the field's tendency to cling to idealized versions of these criteria as a way to deal with disagreements. The situation becomes more complicated for child and adolescent psychoanalysts because their patients are in the midst of a developmental process at the very time they are engaged in a psychoanalytic process. The termination phase of an adolescent male suffering from father loss is presented in depth in order to provide clinical data toward further consideration of the vexing questions surrounding termination in psychoanalysis. His termination is used to examine the relative importance of losing the analyst as a transference object as against a developmental object; the meaning of action during termination; the complicating role of trauma vis-à-vis termination; and the importance of the post-termination phase of analysis. It is suggested that his termination phase demonstrates that a "good enough" termination involves the development of a self-analyzing capacity that continues to evolve and develop after termination.     

Terminating Without Fatality

The psychoanalytic relationship is unique among intimate relationships, in that its ultimate goal is separation. After termination, the analysand mourns the loss of the analyst and while feeling vulnerable and bereft, faces demanding emotional tasks alone. The post-termination phase is a precarious time during which the hard-won gains of an analysis may be threatened or even lost. Given the analysand's vulnerability, it is disturbing that many of our common termination practices may undermine the patient's leave-taking and harm the positive internal images of the analyst and the analytic relationship that have been forged during the analysis. Findings from recent research about the patient's experience after analysis are presented and implications are drawn for practice regarding the termination and post-termination phases. The author recommends that our theory and technique of termination should be reexamined and revised in light of new research and within the context of contemporary two-person theories of psychoanalysis.

In real life, only death and hostility bring a libidinal relationship to an end. The kind of termination psychoanalysis demands is without precedent.

—Martin Bergmann (1997, p. 163)     

To coerce and be coerced

Coercion is a way of forcibly influencing others. While one's core conflicts may contribute to an experience of being coerced in any interaction, specific situations or circumstances commonly encountered in clinical practice set the stage for analyst or patient to feel forced or manipulated. The interaction that develops in these instances is conceptualized as a coercive enactment. Conditions that increase the susceptibility to coercing and being coerced may develop at any stage in the psychoanalytic process. Supervision and conversion from psychotherapy to psychoanalysis are examined as situations that predispose to coercion. Silences and other difficulties in maintaining the analytic frame, as well as crises in the life of the analyst, may also lead to coercive enactments. Pertinent literature is reviewed and illustrative clinical cases are presented.     

Becoming (and Remaining) an Analyst in Latin America

The following overview of the development of psychoanalysis in Brazil and in Porto Alegre outlines the current situation and the challenges to psychoanalysis in my country. I will explain my own experiences on becoming an analyst, the main reasons for my choice, my main influences, and my evolution as a clinical psychoanalyst and as a member of psychoanalytic and psychiatric institutions. I include my main contributions to psychoanalysis and consider two broad areas of interest: psychoanalytic technique and its teaching, and the relationship of psychoanalysis and culture. As for the former, my main interests are studies on countertransference and analytic neutrality, to which I will propose a comprehensive concept. As for the latter, I discuss a culture that contrasts vividly with the one in which Freud created the discipline, psychoanalytic views on violence and perversity, psychoanalytic institutions, and the application of analytic ideas for the understanding of some artists and their work.

I will also describe some general features of my country and the development of psychoanalysis in it; report my experiences as a candidate and an analyst; and offer some information about my evolution as an analyst through papers I have written over the past 30 years.     

Ghosts of paradigms past: the once and future evolution of psychoanalytic thought

An example of the psychoanalytic mode of thought is put forward concerning how psychoanalytic theories have historically been constituted and transformed. The model of world hypotheses, characterized by multiple irresolvable truth claims, captures the nature of most psychoanalytic theorizing until about 1970. Each of two world hypotheses--one grounded in intrapsychic conflict (seen when the analyst observes from outside the transference) and the other in interpersonal internalization (seen when the analyst observes from inside the bidirectional interactive processes)--is an autonomous and self-sufficient aggregate. The stance taken by the analyst-observer with respect to the analytic interaction is key to seeing how the two world hypotheses are made manifest in clinical work and in theory. By contrast, the model of competing programs captures the essential nature of most psychoanalytic theorizing since about 1970, and is characterized by the necessity of each progressively evolving through a particular kind of commerce with its neighbors. Such commerce is necessary when a program is in danger of degenerating. In this way of thinking, there is a fundamental tension between classical psychoanalysis adapting to the demands and exigencies of its particular and ever evolving historical niche and simultaneously retaining the core commitments that guarantee continuity. Honoring the forces of progression displaces the quest for truth as a paramount goal of psychoanalysis. A developmental lag in recognizing this transformation has hindered progress toward a comparative, process-centered psychoanalysis.     

Psychic Truth and the In-Session Work of the Analyst

I seek to address one of the issues most affected by the postmodern culture, such as the crisis of rationality and truth, and try to reformulate its place within the psychoanalytic clinic using the contributions of Freud and Ferenczi, who drew the matrix of a passionate dialogue about the truth and the analyst work that has nurtured many contemporary theoretical developments. Essentially, the major influences of postmodern thought in psychoanalysis are to emphasize the importance of the patient–analyst interaction, the role played by the analyst in the patient’s transference and the rejection of the model of the analyst as a distant observer who interprets without having anything to do with whatever happens within the mind of the patient. Consequently, because both postmodernism and psychoanalysis are concerned with human subjectivity and love for truth, although indeed understanding them from different perspectives, both schools of thought become easily interrelated. I conclude that psychoanalysis, committed as it is with the search for truth, cannot ignore the influence of postmodern thought, as well as the postmodernist movement should not disregard all theoretical consistency provided by psychoanalytic theory and metapsychology.     

Concurrent individual and individual-in-a-group psychoanalytic psychotherapy

This paper's thesis is that concurrent individual-in-a-group and individual psychoanalytic psychotherapy can be conducted in conformance with psychoanalytic principles of treatment as well as can individual psychoanalytic psychotherapy alone. American psychoanalysts have shown little interest in group psychotherapy, probably because of earlier criticism that transference is diluted by the greater reality of the therapist in group psychotherapy. This is a misconception extrapolated from the mirror model of dyadic analytic technique. The criticism was formulated during a period when that model was prominent and there was little awareness that the actual personal relationship between patient and analyst played an important facilitating role in the dyadic analytic process, including providing a basis for investiture of transference. Also, the criticism was based on one-session-per-week group psychotherapy, whereas concurrent individual-in-a-group and individual psychoanalytic psychotherapy utilizes two group sessions plus one or two individual sessions per week, enabling a more intensive patient-therapist relationship. Concurrent group and individual psychoanalytic psychotherapy constitutes a contribution to the widening scope of application of psychoanalytic treatment.     

Erotized transference reconsidered: expanding the countertransference dimension

A reconsideration of the erotized transference from a contemporary perspective has been presented utilizing detailed case material provided by Stoller. The main thesis is that this type of transference, traditionally conceived as a product of a particular kind of patient often felt to be borderline, is better understood as arising in a specific intersubjective context involving both participants in the psychoanalytic situation. The focus is on the intricate interaction of analyst and patient, recognizing that either may serve as a selfobject for the other. This view assumes a more expanded countertransference role than recognized in the earlier literature. The psychoanalytic situation can be erotized by either or both participants. A corollary thesis is that the details of a patient's fantasy should also be viewed as codetermined and that imbedded within it might be the patient's subjective experience of the psychoanalytic interaction. Alluded to peripherally is that the erotized transference in the interaction between male analyst and female patient is, in part, a manifestation of traditional roles assumed in situations involving a male authority figure in close engagement with a female who perceives herself as relatively powerless. This issue has recently received considerable attention from writers who have addressed themselves to the important gender issues in psychoanalysis.     

Making Good Use of Combined Therapeutic Modalities: Discussion of “Somatic Experiencing”

A positive view is taken of integrative analytic and bio-psychological Somatic Experiencing (SE) therapy for trauma. Levit’s case report is viewed as reflecting an early stage of the analyst’s development as an integrative clinician. A risk of integrative treatments is splitting between modalities of analytic functions including affect regulation. The present case is read closely. Commentary focuses on enactment and missed opportunities for analytic reflection, including (transference) meanings of SE interventions. Increased analytic attention to therapeutic process aims to open reflective space to discuss a wide range of experiences in treatment, including disappointments and other (more negative) aspects of transference, deepening the therapeutic experience, and reaching more broadly into sequelae of the patient’s developmental trauma than SE intervention alone. Integrated bio-psychological interventions are compared and contrasted with use of psychotropic medications in analytic therapy. Bio-psychological interventions such as SE have the advantage of adding resources for the analyst’s self-regulation as well.     

Patient-therapist match: revelation or resistance?

Patient-therapist match is a relatively new yet frequently invoked concept within psychoanalysis. Despite Freud's appreciation of the influence of the analyst's past to his or her work within the analytic setting, psychoanalysts have historically held varied opinions about the degree to which the analyst's personality and conflicts affect the analytic process. As analysis was reconfigured as a two-person system, attention focused on the fit between patient and analyst. The literature on patient-therapist match is reviewed, and the conclusion reached that this intuitively appealing concept suffers from a lack of rigorous definition and operationalization. Many authors invoke match in ways that imply that it is real, static, external to the domain of analytic inquiry, and unaffected by analytic process. In its present form, the concept of patient-therapist match obstructs rather than facilitates analytic exploration and obscures rather than clarifies what happens between analyst and analysand in psychoanalysis. By suggesting that match exists as a reality outside the domain of transference and countertransference, analysts may overlook the importance of psychoanalytic technique in creating a sense of match. Analysts may attribute stalemated or limited analyses to a bad match, rather than tenaciously exploring the transference-countertransference configurations that remain at the heart of analytic work.     

“It Ain't Over ‘til It's Over”: Infinite Conversations,Imperfect Endings,and the Elusive Nature of Termination

Despite general agreement as to the importance and subtlety of managing the final (“termination”) phase of psychoanalysis, the way that analytic work is brought to a close has been both undertheorized and problematic in practice. How and under what conditions a psychoanalytic process might best be brought to an end is a problem that has plagued psychoanalytic theorists, clinicians, and their patients from the earliest days of psychoanalysis. Patient and analyst do not discover a “royal road” to the end of analysis. Rather, patient and analyst together forge a trail through the thickets of their work to a juncture at which they find that their paths can once again diverge. This paper attempts to explore the ways in which patients and analysts negotiate these most complex and elusive transitions. Analyst and analysand, having come to recognize the limits of their conscious awareness and the ultimate uncertainty at the heart of the psychoanalytic process, must live with the tension generated in the encounter between the inherent limits that eventually will herald the end of analysis and the recognition of new possibilities that beckon the pair into new byways of analytic exploration. Since we can never be certain when ending analysis forecloses promising avenues of new growth, or when continuing analysis constitutes a collusion between patient and analyst in eluding the difficult but ultimately generative ending of analysis, the author suggests that it is preferable to hold the notion of termination lightly, trying as best he can throughout an analysis to facilitate the exploration of its very boundaries, limits, and possibilities.     

Anna Freud's Analysis by Her Father: The Assault on the Self

Sigmund Freud's analysis of his daughter, Anna, continues to create many troubling questions: For example, in terms of his own theory did Freud envisage the transference reactions of his daughter in her analysis with him? How are we to understand Anna Freud as a well-trained analyst in terms of the inevitable limitations of her analytic experience with her father? Menaker explores the ethical effects of this analysis in regard to fundamental problems in psychoanalytic theory and therapy.     

Developments in cognitive neuroscience: II. Implications for theories of transference

An integration of psychoanalytic theory with contemporary developments in cognitive neuroscience offers a useful perspective on long-standing controversies about the nature of transference, and a better understanding of the precise mechanisms by which transferential processes occur. Contemporary psychoanalytic views of transference are reviewed, and the many processes that constitute transference are described. Two issues that have emerged in different guises for several decades-the role of the analyst in eliciting transference, and the nature of "real" and "transferential" components of the therapeutic relationship-are reconsidered in the light of concepts such as connectionist networks. Although a useful analytic stance is one that allows the patient's enduring dynamics to dominate the analytic field, it is suggested, anonymity is neither a cognitive possibility nor the driving force behind most transference reactions, and the distinction between "real" and "transferential" perceptions is one of therapeutic interest, not of mechanism. Certain features of the analytic situation make some dynamics more likely than others to enter the treatment relationship, notably those related to authority, intimacy and attachment, and sexuality. Transference reactions are best understood as constructed from a combination of the patient's enduring dispositions to react in particular ways under particular conditions; features of the analytic situation and of the analyst; and interactions between patient and analyst. These reactions do not unfold ineluctably from the patient's mind in the consulting room, nor are they cognitive constructions of the patient-analyst dyad or co-constructions of relatively equal partners exerting their influence on the analytic field.     

Developing a Psychoanalytic Practice

Abstract

This paper examines two methods of developing a psychoanalytic practice. The first is an “internal” approach that helps a patient make the transition from therapy to analysis with the same analyst. This may be accomplished by attenuating the patient's unconscious fears of analysis as a facilitator of an anticipated regressive loss of control and as a reactivator of feared desires and impulses. Increased motivation for analysis may also result from a therapy that leads the patient to an awareness that an ongoing level of distress is internal, together with the experience of a deepened therapy and of the analyst as safe and potentially providing relief. The second method of developing an analytic practice is an “external” approach that provides others, such as analytic, mental health, medical, and academic colleagues, an experience of the analyst as person and some idea of the type of work he or she does.     

The infant and the infinite: On psychoanalytic faith – Bion,Meltzer and Kierkegaard

This paper discusses the meaning of psychoanalytic faith as a useful developmental concept, which applies to the therapeutic process in the consulting room as to other intimate educational experiences. Faith is a concept which has been little considered in relation to psychoanalysis, partly owing to semantic confusion with ‘the Faith’ as in religious or psychoanalytic dogma, and partly owing to the difficulty of defining or describing what it is, outside accepted jargon. Yet, faith is traditionally the gateway to experiencing the unknown – a psychoanalytic goal-demanding negative capability. It is suggested that philosophy and poetry, where the concept is more familiar, can provide psychoanalytic parallels for this particular type of learning from experience. The viewpoints of Bion, Meltzer and Kierkegaard are taken as contributing to a picture of how, in the psychoanalytic session, there may be a developmental encounter between the infant (patient) and the infinite (the transference process, rather than the analyst as a person).     

Seeking an Analytic Identity

Abstract

Rothstein has stimulated all analysts to rethink how we can better commit ourselves to our analytic work. In this paper I focus on factors in analysts' personalities and experiences in their training and practice that contribute to or distract from establishing an analytic identity.

First, I explore analysts' background and motivation. In admissions to psychoanalytic institutes we look for candidates who can see psychoanalysis as an intellectual puzzle to be solved and an emotional involvement to be experienced. We look for earlv conflicts that the candidate can sublimate in the service of analytic functioning. We assume that the capacity to sublimate is only partial and that analysts in their development continue to recognize conflicts in transference—countertransference reactions.

Second, I give some examples of experiences from analysts' training that stimulate the formation of their analytic identities. These include transient identifications and counter-identifications with the training analyst, supervisor, seminar leader, and favorite analytic authors.

Third, I discuss more external factors that influence the development of analytic identity. These include the climate in training and continuing education at the institute. How much does the institute support its members in immersion in psychoanalysis? Economic factors continue to he an important factor in determining individual choice in this immersion.

Finally, I review studies on the effectiveness of psychoanalysis. Dedicated analysts with considerable experience believe that analysis works despite some limitations. Part of high motivation to continue analytic work includes understanding how analytic results differ from the simpler solutions achieved by nonanalytic therapies.     

Concerning Transference and Countertransference

This paper is presented primarily for its historical interest. The author's first attempted publication in psychiatry or psychoanalysis, it was submitted successively to two publications in 1949, rejected by each, and filed away until now. In it, the author suggests that transference phenomena constitute projections, and that all projective manifestations—including transference reactions—have some real basis in the analyst's behavior and represent, therefore, distortions in degree only. The latter of these two suggestions implies a degree of emotional participation by the analyst which is not adequately described by the classical view of him as manifesting sympathetic interest, and nothing else, toward the patient. It has been the writer's experience that the analyst actually does feel, and manifest in various ways, a great variety of emotions during the analytic hour. The analytic usefulness of this actual richness of emotional participation, by the analyst, is detailed.     

Vulnerability,Resilience, and Surviving Destruction: Discussion of “The Analyst’s Experience of Trust and Mistrust”

In this response to Danielle Novack’s intellectually astute and clinically rich paper on the “analyst’s trust,” I reflect on the valuable ways in which Novack elucidates this undertheorized aspect of the analyst’s experience and reconfigures trust/mistrust as a meaningful intersubjective dimension of the therapeutic relationship. Novack shows how attending to shifts in trust/mistrust can provide valuable clues for deciphering the transference/countertransference. While I strongly agree with her construction of trust as a psychoanalytic achievement, I question the notion that the analyst’s trust is a necessary condition for her participation. Novack’s work on the analyst’s trust joins a broader contemporary conversation about potential overreaches in the relational paradigm, which I discuss. Finally, I consider the implications of Novack’s work for specifying the factors that underly resilience and engaging a conversation about surviving destruction in contemporary relational psychoanalysis.