Psychic reality and the analytic relationship

In this article I have argued that the more linear transformations or desymbolized expressions of one's earliest relationships are always a part of psychic reality and represent a unique opportunity in the analytic situation to transform a person's emotional orientation to the world. A necessary condition for this to come about is the analyst's capacity for sustained interest in the patient. This interest, which goes well beyond an intellectual one, can be threatened by countertransference as well as certain assumptions the analyst has about the nature of the analytic process. The analyst's belief in the analytic process, a belief that can only come from his or her own analysis, is seen as crucial in helping the transformational process that occurs in a successful analysis.     

SUPERVISION: A CONTAINERÆCONTAINED APPROACH

The authors illustrate an approach to the supervisory process as a learning experience for both supervisee and supervisor built on the containment of unconscious anxieties. It is argued that a core function of psychoanalytic supervision is to help contain the emotional turbulence and the unconscious anxieties arising and evolving in the two interacting domains of the analytic and the supervisory sessions. From this perspective, the analyst-patient interaction and that of the supervisee and supervisor can be understood as twin, tiered transformational arenas, the supervisory one being at the service of holding and grasping the roles the supervisee/analyst goes through as part of the analytic process. On the basis of detailed clinical material from a disturbed 7-year-old girl, the authors explore the interrelated issues and difficulties in containing anxieties and turbulence in both the analytic and the supervisory situation. When emotional containment is adequately handled, the supervision helps the understanding and development of the supervisee's use of his/her own personality as a treatment instrument, as advocated by Fleming and Benedek decades ago. The supervisory session thus furthers the resolution of clinical issues through symbol-formation, clinical sessions and supervision being twin domains for recording and understanding emotional evolution.     

At Death's Door: Therapists and Patients as Agents

This paper explores the interrelationship between patients' exercise of will to make advances in an analysis and their readiness to forgive their analysts for their human limitations. There is a thin line between idealization of the analyst, probably a necessary component of the process, and resentment of the analyst for his or her privileged position in the world and in the analytic situation itself. The patient's “progress” emerges as a kind of reparative gift, one that implicitly overcomes the patient's tendency to withhold such change out a sense of chronic, malignant envy. Particularly poignant in terms of its potential to elicit the patient's reparative concern is the situation in which the analyst is struggling with his or her mortality because of aging or life-threatening illness. In this essay two clinical vignettes are presented to illustrate some of the issues that this situation poses. One begins with an elderly patient appearing at the door of the analyst's (the author's) home the day of his return from the hospital after coronary bypass surgery. The other begins with an analyst who is terminally ill appearing at the door of a patient who is threatening suicide. The two stories are compared in terms of their implications for human agency, the exercise of will, and the coconstruction of meaning in the face of mortality in the analytic process.     

The fate of the dream in contemporary psychoanalysis

Freud's metapsychology of dream formation has implicitly been discarded, as indicated in a brief review of trends in psychoanalytic thinking about dreams, with a focus on the relationship of the dream process to ego capacities. The current bias toward exclusive emphasis on the exploration of the analytic relationship and the transference has evolved at the expense of classical, in-depth dream interpretation, and, by extension, at the expense of strengthening the patient's capacity for self-inquiry. This trend is shown to be especially evident in the treatment of borderline patients, who today are believed by many analysts to misuse the dream in the analytic situation. An extended clinical example of a borderline patient with whom an unmodified Freudian associative technique of dream interpretation is used with good outcome illustrates the author's contrary conviction. In clinical practice, we should neglect neither the uniqueness of the dream as a central intrapsychic event nor the Freudian art of total dream analysis.     

Commentary on Paper by Lawrence J. Brown

Brown's historical overview of post-Kleinian psychoanalysis traces key steps in the evolving and diverse practice of working in the psychoanalytic situation while regarding it as a two-person field. The Barangers' “The Analytic Situation as a Dynamic Field” is central to his narrative. I develop my understanding of the originality of their contribution in theorizing a situational unconscious, and of their continuing relevance for thinking about analytic listening and intersubjective collaboration. Brown presents a countertransference dream of his own along with the dream of a patient as an example of the Barangers' concept of the “shared unconscious fantasy” of the analytic couple. A detailed alternative reading of Brown's clinical vignette reveals an absence of fit with the Barangers' views on collaboration in the analytic situation. Some uses of Bion's “dreaming” and “becoming” are implicitly questioned as they risk encouraging the idealization of special states over process.     

MOURNING IN THE PSYCHOANALYTIC SITUATION AND IN SHAKESPEARE'S THE TEMPEST

Recognizing that mourning builds psychic structure, the author highlights the ubiquitous and essential nature of mourning in the psychoanalytic situation. Reality testing is intimately connected to mourning and is the warp on which psychic structure is woven in the analytic situation. Reality testing necessarily involves opportunities for mourning and thus will be present in every analytic hour. The confrontation with reality is the basis for all processes of mourning, or for creating defenses against this painful experience. The author views mourning as fundamentally a transformational process, and Shakespeare's The Tempest is used to illustrate this aspect of mourning.     

The termination phase of psychoanalysis as seen through the lens of the dream

The decision about when to terminate analysis has long been underpinned by a theory-driven criterion model, which may steer the analytic dialogue away from its customary activities of free association, empathic listening, and interpretation. As a remedy to this situation, the author proposes that by paying careful attention to less consciously crafted patient communications such as dreams, the analytic dyad can consider readiness to set a termination date from a perspective that is context-sensitive and less encumbered by preordained criteria. Tracing the dreams of one analysand from the vantage point of contemporary dream theory, the author demonstrates how careful attention to the dream elucidated the patient's readiness to terminate and her complex feelings about the termination process. Finally, the author challenges the notion that the termination phase is of greater evaluative than therapeutic importance, and provides clinical material as evidence that this is not the case.     

Analyzing disavowed action: the fundamental resistance of analysis

Several detailed analytic hours illustrate how, with the analyst's full participation, patients use the words, setting, and activity of analysis to gratify the very wishes they are analyzing, and so disavow the work of analysis. These gratifications, which are hidden in plain sight, are themselves disavowed in the apparent pursuit of analytic understanding. In this way the patient's and the analyst's use of the analytic situation becomes the fundamental resistance to the work itself. This process shares features in common with perversion. The painful but necessary task for both analyst and patient is to analyze this process as it is occurring, moment by moment, in the real time of the hour.     

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.     

A brief introduction to the work of Jean Laplanche

The author proposes an introduction to the work of Jean Laplanche, a well‐known figure of psychoanalysis who recently passed away. He foregrounds what he views as the three main axes of Laplanche's work: firstly, a critical reading method applied to Freud's texts; secondly, a model of psychic functioning based on translation; and, thirdly, a theory of general seduction. Far from being an abstract superstructure, the theory of general seduction is firmly rooted in the analytic situation, as the provocation of transference by the analyst best illustrates. The analytic situation indeed consists in a revival and a reopening of the ‘fundamental anthropological situation’ which, according to Laplanche, is the lot of every human baby born in a world where he or she is necessarily exposed to the enigmatic and ‘compromised’ messages of the adult other. Thanks to the process of analytic de‐translation, the analysand is therefore granted an opportunity to carry out new translations of the other's enigma – translations or symbolizations that might be more inclusive and less rigid than the pre‐existing ones. Incidentally, such a model brings together the purely psychoanalytic and the psychotherapeutic aspects of the treatment.     

FROM THE FUNDAMENTAL RULE TO THE ANALYSING SITUATION1

The analytic method relies on the mental capacity to produce an associative sequence, and, afterwards, to discern its unconscious logic; within the social practice of the analytic cure, the method presents itself as the mastered enactment of the condition through which free association proves to be possible, interpretable and beneficial. There is a contradiction between the necessity of relying on a former theorisation and that of willingly suspending a knowledge that might serve the authenticity of the experience. The author reminds us of the structural links between the fundamental rule and the defined situations within which the analytic process of transformative investigation can take place. He raises the problems that it is suggested arise with the initial objectivation method by acknowledging the transference as the created‐found object of interpretation. He shows how the transformation of the patient into analysand implies the functional introjection of the various elements contained by the analytic site. The meaning given to the expression ‘analysing situation’ is made explicit. The crucial value of the process of enunciation is illustrated by a brief example.     

Intersubjectivity and interaction in the analytic relationship: a mainstream view

The authors conceptualize intersubjectivity as a meta-theory that reflects the inherent nature of human relatedness and is conceptually independent of any particular theory of mind or school of psychoanalysis. Their view of intersubjectivity joins the emotional life of the analyst to that of the patient and places the analytic relationship at the center of the analytic process. They contrast intersubjectivity with traditional classical conflict theory so as to clarify the relevance of intersubjectivity for psychoanalytic clinical theory and therapeutic practice. In so doing, they hope to direct analysts more firmly toward the study of the unconscious dyadic contributions to the affective, inactive, and interactive dimensions of the analytic situation and their impact upon the patient's actions within and experience of the analytic relationship. To illustrate their thesis, two hours from an analysis are presented in detail.     

Intersubjectivity and the creation of meaning in the analytic process

By means of a clinical illustration, the author describes how the intersubjective exchanges involved in an analytic process facilitate the representation of affects and memories which have been buried in the unconscious or indeed have never been available to consciousness. As a result of projective identificatory processes in the analytic relationship, in this example the analyst falls into a situation of helplessness which connects with his own traumatic experiences. Then he gets into a formal regression of the ego and responds with a so‐to‐speak hallucinatory reaction—an internal image which enables him to keep the analytic process on track and, later on, to construct an early traumatic experience of the analysand.     

Analytic Thinking,Religion, and Prejudice: An Experimental Test of the Dual-Process Model of Mind

Dual-process models of the mind, as well as the relation between analytic thinking and religious belief, have aroused interest in recent years. However, few studies have examined this relation experimentally. We predicted that religious belief might be one of the causes of prejudice, while analytic thinking reduces both. The first experiment replicated, in a mostly Muslim sample, past research showing that analytic thinking promotes religious disbelief. The second experiment investigated the effect of Muslim religious priming and analytic priming on prejudice and showed that, although the former significantly increased the total prejudice score, the latter had an effect only on antigay prejudice. Thus, the findings partially support our proposed pattern of relationships in that analytic thinking might be one of the cognitive factors that prevents prejudice, whereas religious belief might be the one that increases it.     

Why we need to write openly about our clinical cases

To learn more about what is and is not effective in the psychoanalytic situation, analysts need to develop a library of detailed analytic case material. Open case writing, by not overconstraining readers, allows them enough access to the analytic couple's affective experience to persuade them of the authenticity and validity of the analyst-author's views. They are then free to rethink the material creatively on their own, to use it as they need to, and to learn from others, in order to enhance their analytic skills. Closed case writing hinders readers' creative freedom to understand and interpret, and hence to learn. To encourage analyst-authors to share their affective experiences in the analytic situation more openly, analysts need to establish a constructively collaborative attitude toward playing with clinical material. They need to take for granted that new readers, even authors themselves newly rereading their work, will discover something new. A dialectical process can then be established in which clinical authors and readers contribute to each other in an ongoing imaginative interchange.     

The Analysis of Preconscious Phenomena and Its Communication

Thoughts and feelings of both patients and analysis may be influenced by perceptions that remain outside of conscious awareness. A preconscious communication exists between patient and analyst. Appreciation of the preconscious elements of communication may enable a better understanding of what may be otherwise experienced as a mysterious occurrence. Transference-countertransference interactions create a place to observe the manifestation of preconscious phenomena. This paper addresses how the analytic method enables the discovery of consciously unrecognized stimuli or selective attention to certain phenomena which have created a sense of the uncanny or surprising. Both intersubjective reflection and more formal, systematic methods, which include logic and reasoning, serve to illuminate these events. The paper discusses and illustrates the role of preconscious communication in the analytic situation and its relation to the analytic process.     

The clinical concept of analytic process: A conceptual investigation1

The authors discuss the term ‘analytic process’, confi rming the variability of the meanings ascribed to it. Although all the psychoanalysts of this and previous times acknowledge the existence of something called analytic process, as well as its importance, it has not been possible up to now to establish a consensual defi nition of it. The defi nitions are not only numberless, they also contradict one another. The possible advantages to analytic theory and practice proceeding from a uniform concept are incontrovertible. A review of the subject in the psychoanalytic literature has been performed. A conceptual study concerning the term, carried out among members of a psychoanalytic society affi liated to the IPA is presented, no consensual conceptualization for the term analytic process having been found. The subjects referred to the term as deriving from a variety of elements, some in common, but there was no agreement regarding the elements themselves. There was consensus regarding the role of the analytical relationship in the process, considered fundamental, as well as that of the extent to which the individual life experiences in that relationship defi ne the unique character acquired by the process within it.     

Psychic reality in the psychoanalytic process.

The case is made for regarding psychic reality as synonymous with subjective (conscious) experience, which is inherently open to, but not reducible to, unconscious determinants. Both analyst and analysand engage in the analytic relation and interaction from the perspective of their respective psychic realities. Thus, components of the analytic relation--transference/countertransference, alliance, and real relation--are forms of psychic reality. The tensions of subjectivity and objectivity are discussed in relation to the analytic situation, especially with regard to whether the patient's or the analyst's psychic reality is to be given priority or preference. The same reality, situation, or relationship can be viewed from different perspectives and subjected to varying interpretations without any one being exclusively true or false-each may be partially true and/or partially false. The patient's recounting of his history is a part of the patient's psychic reality that intersects with a necessarily divergent account constructed by the analyst. The ensuing dialogue seeks a form of real coherence that is mutually realistic and makes realistic sense for both parties. Reliance on subjective psychic reality becomes a possible, but precarious and potentially misleading, basis for analytic understanding without other observational (verbal and behavioral) or objective data.