Psychoanalytic interpretation of the Rorschach: do we have better hieroglyphics?

Schafer (1954) advanced the "Psychoanalytic Interpretation in Rorschach Testing" and asserted that thoughtful interpretation involved more than translating hieroglyphics or scores. In this book, he presented his thesis by describing four defensive styles (repression, denial, projective, and obsessive-compulsive) at various levels of severity of psychopathology. To investigate whether the Structural Summary data from Exner's (1986) Comprehensive System, with its improved reliability and validity and additional scores, allow one to make similar distinctions among the types of defense and severity of disturbance, we rescored the Schafer records. The results of this conservative test of Exner's system suggest that (a) the Comprehensive System reliably distinguishes the repressive style from the other styles, and (b) scores alone may provide adequate measures of severity of disturbance even with form quality excluded. We concluded that Rorschach scores must be understood as complex products of multiple psychological operations and may correspond to different subjective experiences in various contexts.     

Flexibility of the Psychoanalytic Approach in the Treatment of a Suicidal Patient: Stubborn Silences as “Playing Dead”

The author presents the clinical case of a patient in his third analysis who seemed emotionless, did not feel alive, and complained of an uncontrollable urge to gamble, with disastrous financial results. His previous four-session-a-week “orthodox” analysis had left him prey to a sense of emptiness and to intense suicidal urges. He wanted only two weekly sessions, which became three after some analytic work. The author stresses the danger of rigidly following inflexible standards and the consequent activation of a pseudo-compliance in the analysand. A more slowly paced psychoanalysis should not be considered lower in the pecking order than “high-frequency” treatment, the author maintains: It requires great creative subjective involvement on the part of the analyst and close interaction in the context of the analytic couple. The author shows how this analysis involved a series of interactions in which the analyst was called upon to exercise a complex responsiveness, attuned in each instance to the patient's current needs. Finally he focuses on some clinical passages to show how the patient's internal theories represent a glaring assault on common sense and how death was not recognized perceptionally on a realistic level, but was instead replaced with acting out death against himself by keeping himself mentally dead and by suicidal urges.     

Radicalizing the Role of the Emancipatory Teacher in the Crisis of Democracy: Erich Fromm’s Psychoanalytic Approach to Deweyan Democratic Education

Studies in Philosophy and Education - This paper explores Erich Fromm’s contribution to Deweyan democratic education by referring to his psychoanalytic interpretation of John Dewey’s...     

The Position of Metapsychology in the Formation of Psychoanalytic Knowledge and the Concept of “I” (Ego)

Psychoanalysis is unique in that competence in the field can be achieved only through applying the method to oneself. Different psychoanalytic schools differ in their understanding of the unconscious, about how to approach it, or how to define the specificity of the psychoanalytic interaction. Consequently, there are differences in the criteria for the definition of the ‘good-enough analysis’. There are many different opinions about how to select candidates, organise the curriculum and length of training. To define psychoanalytic talent is difficult; the uncertainty in the definition of criteria to use for selection is great; the problematic overlap between personal analysis and training is constantly present; to achieve conditions in which learning and creativity can develop is complicated by trainee, supervisor and their relationship to the Institute. Confrontations about training are often heated and divergent, as well as repetitive. Systematic studies about psychoanalytic education are very few. After a short discussion of the different concerns about selection, personal versus training analysis and the ambiguities of the supervisory situation, the author gives a review of three studies on how psychoanalytic education—as viewed by trainers and trainees—is conducted and experienced at the Swedish Psychoanalytic Institute. Training is felt to be well grounded in theory and tradition; nonetheless most do not have a sufficiently clear picture of training as a whole. Both candidates and trainers see the development of a psychoanalytic identity as the goal of training, where the competencies to be acquired are equated with important personality qualities. The candidates have a feeling of “being chosen"; they “wish to belong to a group who share an interest and fascination for psychoanalytic thinking and theory". All praise the warm and open atmosphere, and the mutual and continuous evaluations and the deep involvement of all. The surge to be rooted in an overreaching psychoanalytic ethic, the culture of gratitude within the Institute and the devotion to the task to train psychoanalytic clinicians for the future may preserve an idealised image of psychoanalysis and the fantasy that psychoanalysts are exceptional persons and give a mystifying colour to the psychoanalytic profession. This might also stand in the way of a more radical change in the traditions of training—according to the rather drastically changing climate in which psychoanalysts of the future will have to work.     

Psychoanalytic inpatient psychotherapy of depression – Two naturalistic samples throughout the course of a decade

Background: While the general effectiveness of psychodynamic inpatient psychotherapy has been established, very few studies have specifically investigated the effectiveness of psychodynamic inpatient treatment of depression, though depressed patients represent the largest group of inpatients.

Method : This study investigated two naturalistic samples of depressed patients regarding treatment outcome as well as clinical and treatment characteristics. Patients were treated in a psychoanalytical psychosomatic hospital unit. Data was collected from 2000 to 2002 (N=234) and from 2008 to 2010 (N=514). Data was acquired at admission and discharge.

Results: The findings reveal high pre-post effect sizes for symptom reduction (SCL-90-R), general functioning (GAF) and medium changes of interpersonal problems (IIP). The improvement on the IIP was significantly higher for patients with comorbid personality disorder. Based on therapist ratings, the sample treated from 2008-2010 showed higher levels of impairment on several levels: chronic, complex, functional (GAF) and structural (OPD).

Conclusion: Findings indicate that patients show substantial short-term benefit following psychoanalytic inpatient psychotherapy, as practiced under naturalistic conditions. Open questions remain regarding the long-term nature of these benefits and the possible influence of placebo-effects.     

Even More Than the “Something More”: Tronick’s Dyadic Expansion of Consciousness Model and the Expansion of Child Psychoanalytic Technique

Contemporary psychoanalysis considers itself to be a discipline fundamentally concerned with meaning and meaning-making processes. Ed Tronick’s research provides scientific support for the theoretical position that meaning making is a central process in psychological development and in mental health/illness. His work collaborating with psychoanalysts has made major contributions to the psychoanalytic literature on therapeutic action, with a special emphasis on the means by which implicit meanings are activated and modified in analytic treatment—the something more than interpretation. This article is about a different something more, the even more that psychoanalytic theory and technique can evolve through further incorporating Tronick’s important findings. Tronick’s Dyadic Expansion of Consciousness Model will be briefly reviewed—emphasizing his conceptualization of meanings as being composed of multiple commingling layers (biological, psychological, relational, and social) coming together in a nonlinear “messy” mixture of mutually influencing (both bottom-up and top-down) currents. This multilayered model of meaning opens up the reconsideration of an exciting array of technical options—traditionally considered nonanalytic—to be reunderstood as truly psychoanalytic in that they address one or more of the implicit or explicit levels of meaning that a patient makes of his or her self and world. Examples of these interventions include parent work, work with teachers and schools, as well as interventions adapted from other disciplines such as Occupational Therapy. These technical possibilities are illustrated using case material from the psychoanalytic treatment of a nine-year-old boy.     

Extending the Field of Psychoanalytic Change: Exploratory–Assertive Motivation,Self-Efficacy,and the New Analytic Role for Action

Psychoanalysts' interest in the need for exploration and assertiveness, originally investigated empirically during the 1940s and 1950s, has recently been revived (Lichtenberg, 1989; Lichtenberg, Lachmann, and Fosshage, 1992, 1996). Exploratory–assertive motivation has been seen as a basic motive that interacts with several other forms of motivation to fulfill and regulate the person's basic needs, direct interpersonal relations, and maintain the organization of the self. In this paper, it is reasoned that recognizing and systematically and actively integrating the pervasive influence of this powerful motivational system outside, as well as within, psychoanalytic sessions can usefully redefine and broaden the scope and reshape the thrust of many psychoanalytic interventions. Three specific areas of psychoanalytic technique are probed in relation to exploratory–assertive motivation: enhancing patients' feelings of self-efficacy, shading interpretations toward action, and promoting adaptive coping skills. Patients' achieving enhanced feelings of self-efficacy—gaining confidence in their ability to perform—deserves to be elevated, explicitly, as an important aim of psychoanalysis. Clinical illustrations are offered.     

In Defence of the Real: The ‘Pathology’ of Violence in Buddhist Folk Rituals and Statecraft of Sri Lanka: A Psychoanalytic Review

According to Slavoj Zizek, ‘Real’ is the world before it is carved up by the Symbolic. The Symbolic is the big Other that distorts/represses the Real. Fantasy is the mask that covers up this distortion and makes people of necessity live with repressed or sublimated forms of pleasure in different versions of the Symbolic. The discontent that issues from this inhibition constitutes psychic trauma and manifests in clash of denominational and racist fantasies. In this article, I attempt a Lacanaian-Zizekian analysis of the traumatic that inflects the subject positions in violent Buddhist state politics of Sri Lanka and seek to trace its continuity in the (anti)-ethics of Sinhala Buddhist folk rituals practised in the southern (low) part of the country. The psychodynamics of violence that engender the political engagement of the state, the JVP and the LTTE in the 1980s are not dissimilar from that of the sacrificial violence of Buddhist exorcism rituals in vogue in parts of Sri Lanka today. This is a fresh attempt to understand why violence becomes ‘unavoidable’ even in denominational identities that otherwise preach ahimsa (non-violence), and in statecraft that professes to be governed by such principles.     

“Ablation of the Parental Images”: A Secret Core in Charles Rycroft’s Psychoanalytic Thought

This article arises from the need to “present” (that is, to read again in a “present and actual” light) the paper, “Why Analysts Need Their Patients' Transferences” by Charles Rycroft (which first appeared in 1993 and is re-published in this Special Issue), and is therefore strictly connected to the ideas the latter contains. The authors, on the one hand, outline the stages of the journey that took Rycroft to elaborate the concept of “ablation of the parental images”, and on the other, retrace his personal “analytic genealogy” and discover a “missing forefather”, Sándor Ferenczi, who has represented for a long time a direct “missing link” in the history of psychoanalysis.     

A Psychoanalytic Grave Walk—Scenic Memory of the Shoah. On the Transgenerational Transmission of Extreme Trauma in Germany

In this article we describe a phase of a long-term psychoanalysis of a daughter of Shoah Survivors. The article is part of a research project conducted at the Sigmund Freud-Institute in Frankfurt/Main. The focus of the study is on the transmission of extreme trauma from the First to the Second Generation, with special reference to Germany. "Scenic memory of the Shoah" is presented as a concept that stresses the non-verbal, unconscious communication between the generations. The so-called "concretistic" behavior of the Second Generation, which has been described in the literature, is conceptualized here as scenic memory of the traumatic experiences during Nazi persecution, that is, a highly symbolic and metaphorical expression of the extreme trauma handed down to the patient by the parents.     

On Difference and the “Beyond Psychotherapy” of Psychoanalytic Method: The Pivotal Issue of Free-associative Discourse as De-repressive Praxis

The American Journal of Psychoanalysis - It is argued that, in the course of the history of psychoanalysis since 1914 or thereabouts, the clinical and theoretical interests of psychotherapy have...     

In Search of the Person in the Patient: An Interpersonal Perspective on “Roles in the Psychoanalytic Relationship”: Commentary on Paper by Richard Almond

I am postulating an irreconcilable discrepancy between psychoanalytic metapsychology and praxis. Metapsychology reaches for the abstract, for the general class of which the patient is an ostensible member—said class, somewhat tautologically, demonstrating the validity of the professed metapsychology. Yet, from the Interpersonal view, therapy depends on grasping the highly idiosyncratic way the patient plays out his or her life both in and out of the therapy room. Abstracting the patient concretizes the process and reduces information. As a consequence, the clinical material falls short of utilizing the rich, recursive patterning of the therapist's exchanges with the patient, failing to fully realize the uncanny enmeshment of unconscious gears that so defines the psychoanalytic mystique.     

Psychoanalytic Depth: A Contemporary Concept?

Although it sounds antiquated to refer to psychoanalysis as “depth psychology,” we continue to use the metaphor in relation to our clinical work. What does depth mean as we think about and engage in our work today? This is an introduction to three different arguments for a contemporary understanding of psychoanalytic depth followed by a discussion.     

The Predictive Power of Horney’s Psychoanalytic Approach: An Empirical Study

This study investigated the construct validity of a measure of Karen Horneys (1945) psychoanalytic theory that postulated three neurotic trends: compliant, aggressive, and detached. Her theory was operationalized by the Horney-Coolidge Type Indicator (HCTI). One hundred seventy-two adults completed the HCTI and the short form of the Coolidge Axis II Inventory, a measure of the three DSM-IV personality disorder clusters. Multiple regression and canonical correlation analyses revealed significant and differential patterns of the three HCTI dimensions with the three clusters. Because Paris (1994) has noted that Horneys neurotic trends may today be conceived of as personality disorders, one implication of the present findings is that Horneys dynamic theory can be valid and useful in the general understanding of personality disorders from a cluster perspective.     

“Ghosts in the Psychoanalytic Nursery”: Response to Lieberman & Harris

In this discussion, I elaborate on the question of why fear, per se, has been relatively absent from psychoanalytic dialogues, and of how to think about the relative primacy of fear, aggression, and infantile sexuality. In response to Harris, I consider some of the ways that contemporary neuroscience and evolutionary theory deepen this discussion. And, following Lieberman, I reflect on why it can be so difficult to hold and process our patients’ fear and trauma.     

Response to MacIntosh’s Systematic Review of Psychoanalytic Couple Therapy: A Brief Note from the Classical Perspective

ABSTRACT

Working with couples from a classical perspective can be thought of as an oxymoron, unlike working from object relations and relational viewpoints, often seen to be the more natural fits. This article offers a fresh look at those parts of the classical perspective that relate very clearly to working with two partners in a couple. Freud’s theories in Three Essays on the Theory of Sexuality (1905) and On Narcissism (1914a) provide theoretical background for the work. Concepts such as transference (between partners, between the partner[s] and the therapist) and countertransference are shown to be manifested in complex ways with couples. Being mindful of unresolved developmental issues—for example, Oedipal and separation-individuation issues—which may have played a part in partner choice and in the resulting problems, allows the therapist to offer deep interpretations of within- and between-partner conflicts. Interestingly, unresolved Oedipal issues, particularly, may form an important part of the countertransference.     

The Man of the House: Commentary on Thomas Burkhalter’s “Foregrounding Masculinities in Psychoanalytic Psychotherapy”

Thomas Burkhalter is complemented on so vividly bringing the reader into his personal struggles to find a true masculinity in the unforgiving context of contemporary South Africa where White masculinity is associated with apartheid. The struggle to be free of old identifications with the patriarchal order and gender binaries saturate the paper, and attention is drawn to the lingering presence of older conceptions of masculinity as a monolithic concept that leaves women as victims and nurturers and the male as dominant. Burkhalter’s clinical vignette is examined and found to illustrate well his struggle and to capture the vulnerability to genderized enactments and the enduring presence of the old order manifested by a reliance on defense analysis that constrains his construal of Mr. Jones’s statement that he is “after all the man in the house.” Potential alternative meanings of this phrase that foreground grief, hope, and a plea for companioning in pain are offered and a deeper engagement with Mr. and Mrs. Jones’s conscious and unconscious worlds is encouraged.     

How Does Change Occur Within the Psychoanalytic Encounter?

On November 6, 2002, Dr. James Fosshage delivered the following talk at a Clinical Training Conference held at the Blanton-Peale Institute. The Clinical Training Conference at Blanton-Peale provides experiential and conceptual resources to support the therapist-in-training in the context of his/her professional identity. The training conference is attended by candidates of all phases of the Psychoanalytic Program, the Pastoral Psychotherapy Program, and the Marriage and Family Program, as well as faculty members, administrators, staff, and interns of the institute. The residents were asked to review three articles written by Dr. Fosshage in preparation for his presentation: Toward Reconceptualising Transference: Theoretical and Clinical Considerations, International Journal of Psycho-Analysis (1994) 75 (2): 265–280; Countertransference as the Analyst's Experience of the Analysand: Influence of Listening Perspectives, Psychoanalytic Psychology (1995) 12 (3): 375–391; and Listening/Experiencing Perspectives and the Quest for a Facilitating Responsiveness, Conversations in Self Psychology: Progress in Self Psychology, (1997) 13: 33–55.     

Self-constitution and “Infrastructural” Change: An Interdisciplinary Account of Psychoanalytic Action

The American Journal of Psychoanalysis - Beyond revealing unconscious pathological identifications and traits—including their past usefulness but current toxicity—what techniques in our...