Shame in Relation to the Body,Sex, and Death: A Clinical Exploration of the Psychotic Levels of Shame

This paper explores the topic of shame in relation to the body, viewing it as the expression of a basic conflict that threatens to obstruct the growth of personality by breaking up the body-mind relationship. The paper presents the psychoanalysis of a psychotic patient whose paranoid shame was associated with the delusion of being noticed. During this analysis, the patient's bodily manifestations and hatred were acknowledged as related to his getting closer to an authentic existence of his own. Particular emphasis is given to the analyst's involvement in the analytic process, in the form of both bodily countertransference and dream activation. The containment and working-through of concrete aspects of hatred and death anxiety, together with the analysand's recognizing the value of sensory perception of his own body, fostered an abatement of symptoms, including his tendency to flee and to attempt to burst the confines of his body. The activation of a connection with the body seems a prerequisite to the development of abstract thinking. The paper describes similar dynamics in two vignettes of less dramatic clinical cases.     

Listening to the Erotic Commentary on Paper by Eric Sherman

In this commentary I examine homoerotic countertransference within the context of the analyst's erotic countertransference experience. Discussing male analysts' difficulties receiving and experiencing homoerotic feelings as a function of their dominant erotic desires (along gender lines), I propose both cognitive and affective explanations to illuminate their defenses. I suggest that Sherman's erotic countertransference is best understood when viewed as a product of both induced feelings emanating from his patient's dissociated sexual abuse and also his anxiety and shame in response to particular relational configurations with his patient that arouse him. Finally, I point to the site of the transgressive as integral to the construction of erotic desire and suggest shifts that need to occur in the erotic subjectivity of this dyad so that the treatment can move forward.     

Tactics and empathy: Defences against projective identification

In this paper the author argues that interpretations made when the analyst has not done the emotional work of recognising and bearing what kind of object she has become in the patient's psychic reality will be experienced as empty tactics – even lies – rather than interpretations of integrity. However, interpreting from a position of bearing the truth of the patient's perception will be technically difficult and indicate turmoil as the analyst struggles to take in the patient's view of her. If the analyst avoids integrating her own picture of herself with the patient's picture (despite giving voice to the patient's picture) the split inside the analyst will be felt and intensify the patient's need to split. Vignettes demonstrate how the analyst, believing she is trying to understand, may become a projective‐identification‐refusing object and the issue of the analyst's disclosure of her countertransference is examined. Ultimately, the author argues, a capacity to receive and bear projective identification requires empathy with both patient and analyst‐as‐patient's object, engaged in a process about which both are ambivalent.     

Projective identification,containment and sojourn in the psyche: Clinical notes on a specific type of transference-countertransference interaction

Abstract

This paper suggests that the interplay between transference and countertransference is considered to be a valuable channel of communication. The author puts an emphasis on the containing function of the analyst. The patient strives for an experience of an object (analyst) that tolerates and copes with the patient's projections. There are some moments when analysts feel themselves to be invaded, controlled or abused by their patient's products. As Bion has postulated, this situation takes the form of a sojourn in the analyst's psyche. Clinical vignettes are given to provide support for the ways in which the analyst contains and elaborates the projections of the patients in his or her own mind and the therapeutic role that these processes have.     

The breadth and boundaries of a self‐psychological immersion in shame a one‐and‐a‐half‐person perspective

Shame colors other feelings and perceptions about the self. From reflections about his own personal experiences and observations regarding a particular manic‐depressive patient, the author discusses the evolution of his current clinical and theoretical understanding of shame. The framework of analytic self psychology is offered as a particularly useful perspective from which to consider shame, with its emphasis on the concept of selfobject to account both for shame's development (through selfobject misattunement and unresponsive‐ness) and for its amelioration (through empathic mirroring, idealization, and twinning). A developmental sequence for shame is advanced reflecting limitations in selfobject responsiveness, and problems are noted in the ability of current self psychology theory to fully account for the alleviation of shame. The self plays its part in the construction of those selfobjects needed to ease shame, representing the “one‐and‐a‐half‐person psychology”; of the paper's subtitle. Finally, the important role of countertransference shame is considered through a clinical example of therapist disclosure of his own shame to his patient, utilized in order to repair an interrupted kinship selfobject transference.     

Working in the countertransference

Ferenczi (1988) described the procedure of mutual analysis, in which the patient and analyst switch roles for part of the time in the analysis. This procedure allowed patients in stalled analyses to make progress and enabled the analyst to overcome certain countertransference blocks but was ultimately rejected for certain drawbacks. Working in the countertransference is a modification of mutual analysis that retains some of its benefits and eliminates some of its drawbacks. In such work, the psychoanalyst's personality and psychodynamics become the center stage of the manifest content of the session; the analyst avoids interpretations of the transference and, instead, elicits the patient's detailed understanding of the analyst's psychodynamics. The analyst does not, however, generally volunteer his free associations or facts about his own life. This process allows deep work with patients with a predominance of projective identification. Working in the countertransference may be preferred in cases of severe psychopathology to other procedures for its lessening of the frequency, severity, and persistence of transference psychoses. The procedure is also a useful supplement to transference analysis with neurotic patients, for whom it can break through blocks caused by anxiety‐laden issues or countertransference impediments.     

Private Terrors Sexualized Aggression and a Psychoanalyst's Fear of Her Patient

This clinical paper explores the meanings and evolution of an analyst's reaction of fear in relation to her patient's sexualized aggression. From both an intrapsychic and an intersubjective perspective, the author analyzes the coconstruction of this transference—countertransference phenomenon. Case vignettes illustrate the author's attempts to address her patient's sexualized aggression while struggling to free herself from the feelings of intimidation and fearfulness stirred by his sadomasochistic fantasies and patterns of interaction. The analyst's unconscious identification with the patient's disowned femininity and narcissistic vulnerability is seen as central to this countertransference “stranglehold.” Release from the analyst's masochistic position comes through a shift in her own affective participation. The importance of the analyst's recognizing her own unconscious contributions to this sadomasochistic dynamic is emphasized and elaborated. Discussion also focuses on the relevance of gender to the issue of countertransference fear, as illustrated in this particular male patient—female analyst dyad.     

On shame,countertransference, and analytic style

Some analysands experience a restricted space in the analytic situation with special counter-transferential consequences. The author discusses how shame is involved in these situations, and projected on to the analyst. This leads to an important choice of direction for the analyst regarding counter-transference acting out or conditions for a real analytic situation. Shame plays a special rôle in these choices of direction. The author illustrates the problem with a clinical vignette and shows how integration of shame is accomplished clinically, and continues with a discussion of the connections between the analyst's analytic style, his own communicative style as a defense against shame and the analytic styles of different analytic “schools”. A discussion of Liberman's concept, of “asymmetrical dialogue” and its connection with countertransference acting out and analytic styles, forms a conclusion to the paper.     

THE PATIENT'S OBJECTS IN THE ANALYST'S MIND

In every analysis, the analyst develops an internal relationship with the patient's objects—that is, the people in the patient's life and mind. Sometimes these figures can inhabit the analyst's mind as a source of data, but at other times, the analyst may feel preoccupied with or even invaded by them. The author presents two clinical cases: one in which the seeming absence of a good object in the patient's mind made the analyst hesitate to proceed with an analysis, and another in which the patient's preoccupation with a “bad” object was shared and mirrored by the analyst's own inner preoccupation with the object. The use and experience of these two objects by the analyst are discussed with particular attention to the countertransference.     

On the process of the psychoanalytic psychotherapy with the borderline depressive patient

Abstract

A certain subgroup of borderline patients often presents depressive symptomatology (either chronic or periodic) and an underlying borderline personality organization.

In this article, the effort is directed at elucidating the psychoanalytic psychotherapeutic process of these borderline depressives by presenting clinical fragments of several psychotherapeutic cases.

The process goes through periods of activation of the patient's depressive or primitive mental functioning, which also reflects on the therapist's countertransference.

The capacity of the therapist to tolerate and elaborate on his patient's projections, facilitates the development of the therapist-patient communication and plays a significant role in the therapeutic outcome itself.     

Early trauma and affect: the importance of the body for the development of the capacity to symbolize

In this paper I aim to outline the importance of working clinically with affect when treating severely traumatized patients who have a limited capacity to symbolize. These patients, who suffer the loss of maternal care early in life, require the analyst to be closely attuned to the patient's distress through use of the countertransference and with significantly less attention paid to the transference. It is questionable whether we can speak of transference when there is limited capacity to form internal representations. The analyst's relationship with the patient is not necessarily used to make interpretations but, instead, the analyst's reverie functions therapeutically to develop awareness and containment of affect, first in the analyst's mind and, later, in the patient's, so that, in time, a relationship between the patient's mind and the body, as the first object, is made. In contrast to general object‐relations theories, in which the first object is considered to be the breast or the mother, Ferrari (2004) proposes that the body is the first object in the emerging mind. Once a relationship between mind and body is established, symbolization becomes possible following the formation of internal representations of affective states in the mind, where previously there were few. Using Ferrari's body‐mind model, two clinical case vignettes underline the need to use the countertransference with patients who suffered chronic developmental trauma in early childhood.     

The Analyst's Anticipatory Fantasies: Aid and Obstacle to the Patient's Self-Integration

In this paper I explore instances of enactment related to the analyst's feelings and fantasies about how analysis will proceed. As I discuss a patient who was developing a new capacity to experience conflict, I explore how the analyst's fantasies about the impact of his interpretations may be utilized in helping him to elaborate and understand the patient's unconscious fantasies and identifications and unintegrated feeling states. In so doing, we sometimes discover how we are unwittingly influencing or avoiding understanding our patient's own version of their psychic catastrophe. As we develop language where there was previously no integrative language for the patient's internalized and interactive version of catastrophe, we always project particular kinds of expectations into the therapeutic situation.     

The shame of existing: An extreme form of shame

This paper presents ‘the shame of existing’ as a form of shame that is deeper and more extensive than those customarily encountered. ‘The shame of existing’ is defined as shame about existing as we are and especially at the fact that we are. It is accompanied by merciless and total rejection of the subject's self and by feelings of extreme worthlessness and inferiority coupled with the all‐pervasive conviction that it would be better not to exist. On the basis of clinical material, consideration is given to the specific transference and countertransference aspects of analyses in which the shame of existing constitutes an important part of the patient's pathology. Disturbance of handling and holding by the primary objects right from birth is suggested as the earliest developmental basis of the shame of existing. This disturbance is attributed to hate and rejection of the infant by the primary objects and to the infant's not being touched emotionally and physically and not having its right to exist acknowledged. The paper begins with an introduction to shame as an affect and as a concept in psychoanalytic theory.     

Rationality through the Eyes of Shame: Oppression and Liberation via Emotion*

Standard accounts of shame characterize it as an emotion of global negative self‐assessment, in which an individual necessarily accepts or assents to a global negative self‐evaluation. According to nonstandard accounts of shame, experiences of shame need not involve a global negative self‐assessment. I argue here in favor of nonstandard accounts of shame over standard accounts. First, I begin with a detailed discussion of standard accounts of shame, focusing primarily on Gabriele Taylor's standard account (Taylor 1985). Second, I illustrate how Adrian Piper's experience of groundless shame can be portrayed as 1) both a rational and an irrational experience of shame, in accordance with Taylor's account as a paradigm model of standard accounts of shame, and 2) as a rational experience of shame when taken in its own right as a legitimate, rational account of shame (Piper 1992/1996). Third, without denying that some experiences of shame either are or can be irrational experiences of shame, I elucidate how standard accounts of shame can act as mechanisms of epistemic injustice, and in doing so can transmute the righteous indignation of the marginalized by recasting them as shameful experiences (that is, by recasting them as experiences of the righteous shame of the marginalized).     

The analyst's countertransference to the psychoanalytic process1

There is countertransference, not just to individual patients, but to the process of psychoanalysis itself. The analytic process is a contentious topic. Disagreements about its nature can arise from taking it as a unitary concept that should have a single defi nition whereas, in fact, there are several strands to its meaning. The need for the analyst's free associative listening, as a counterpart to the patient's free associations, implies resistance to the analytic process in the analyst as well as the patient. The author gives examples of the self‐analysis that this necessitates. The most important happenings in both the analyst's and the patient's internal worlds lie at the boundary between conscious and unconscious, and the nature of an analyst's interventions depends on how fully what happens at that boundary is articulated in the analyst's consciousness. The therapeutic quality of an analyst's engagement with a patient depends on the freeing and enlivening quality, for the analyst, of the analyst's engagement with his or her countertransference to the analytic process.     

The therapist's pregnancy: Evocative intrusion

This paper is concerned with addressing the complex impact of the therapist's pregnancy on the analytic treatment process. The pregnancy is seen as intensifying the transference and countertransference material so that the therapeutic work becomes more strenuous as well as more fluid, with the potential for significant therapeutic change. The paper is divided into two parts. The first section attempts to conceptualise the meaning of the experience for the therapist and patient within the framework of psychoanalytic theory. Problems of technique and management resulting from the pregnancy are examined. One of the issues considered is the manner and timing of the patient's recognition of the pregnancy. The second section of the paper contains extensive clinical material illustrating the enriched transference and countertransference processes, and the access these allow to psychotic pockets of the personality, hitherto largely unavailable for exploration.     

The Unseen Spouse: Pitfalls and Possibilities for the Individual Therapist

Individual therapists often hear a great deal about our patients' spouses or partners, and naturally develop ideas and beliefs about that unseen other and about the causes of any relationship difficulties the patient reports. Not uncommonly, therapists can lose touch with the fact that their impressions of an unseen spouse are constructions that have emerged from the transference/countertransference field, based on only partial or limited information—not veridical truths. They can then talk with the patient about his or her partner or relationship issues in ways that can ultimately do both patient and spouse a significant disservice and perhaps distract from the patient's own issues and analytic goals. This paper discusses several factors that seem to contribute to the development of this problematic dynamic, including various qualities of the transference/countertransference field, and offers suggestions for avoiding or reducing it. Clinical material is used to illustrate key points.     

Psychoanalyst's Values and Countertransference

On the subject of countertransference we attempt to establish a line of continuity between Freud's own expression "blind spot" and Fromm's idea of "counterattitude". It is pointed out that both expressed the idea of the analyst's unconscious as an "instrument" for understanding the patient's unconscious. It follows that the decision to openly use or not to use countertransference in analysis also depends on the concept we have of it and on its extent. The psychoanalyst's real and illusory values and his convictions with regard to human nature influence the countertransference and the analytic relationship. Analytic listening itself may be distorted by it. We must be highly aware of this to avoid enclosing what the patient says in a theoretic scheme. What is needed, therefore, is an open theoretic scheme, more oriented towards understanding than interpretation. Aspects of analytic communication and of the relationship between language, thought and insight are examined. A humanistic point of view is assumed in distinguishing between the transferral and the real plane, and the reasons behind the legitimacy of such a distinction are expounded.     

The Therapist,the Patient,and the Therapeutic Setting: Mutual Construction of the Setting as a Therapeutic Factor

The author examines several types of therapeutic action intrinsic to Davies's clinical work. Among these actions was Davies's eventual and careful willingness to ask her patient to hold affective states that the patient had previously been unable to hold; to discover a way to speak to her patient about her own struggles with the patient while risking, and actually knowing, that, inevitably, some of the patient's discovery of what the analyst feels will resonate with painful past experience; to create another countertransference space in which Davies found a way to become a different kind of bad or disappointing object to the patient than the patient's earlier disappointment with parental figures, though one that proved much more helpful and bearable than her previous experience; and eventually, though implicitly, to accept the aggressive and harsh ways in which the patient was already experiencing newness in the context of repetitive disappointment. In each of these types of action, the opportunity for mourning figures prominently.