Narrative as a hermeneutical relationship to the unconscious

In this article, what seems to have been two central tenets in contemporary psychoanalytic narrative theory are challenged. The one—propounded by Roy Schafer—is that the goal of psychoanalytic work is to furnish the analysand with an alternative narrative. The other—propounded by Donald Spence—is that any story will do, if only it is coherent, consistent, persuasive and encompasses the known “facts”. Basing his critique of the mentioned standpoints on an intersubjective understanding of psychoanalytic work and a concept of interpreting inspired by the existential hermeneutics of Martin Heidegger, the author discusses the nature of the analytic dialogue and the role of transference together with the ethical basis of truth in the analytic project. Finally, it is indicated that there is a limit to analytic working-through, where the analysand's narrative activity must come to a halt and room be left for a resolve, where the analysand may undergo a fundamental transformation.     

PSYCHOANALYSIS AND COGNITIVE BEHAVIOUR THERAPY ‐ RIVAL PARADIGMS OR COMMON GROUND?3

The author suggests that contemporary enthusiasm for cognitive‐behavioural therapy reflects our longing for swift, rational help for psychological suffering. Competition for funding threatens the psychoanalytic presence in the public sector. The psychoanalytic and cognitive‐behavioural models are contrasted, and the relative richness of the psychoanalytic paradigm outlined. The author suggests that a cognitive model is commonsensical, but less complex, with less potential explanatory and therapeutic power. She discusses how the analytic stance is always under pressure to ‘collapse’ into simpler modes, one of which resembles a cognitive one. This also occurs inevitably, she argues, when attempts are made to ‘integrate’ the two models. Cognitive and ‘integrated’ treatments nevertheless have the advantage that they are less intrusive and hence more acceptable to some patients. Selected empirical process and outcome research on cognitive and psychoanalytic therapies is discussed. Brief psychotherapies of either variety have a similar, modestly good outcome, and there is some evidence that this may be based more on ‘dynamic’ than ‘cognitive’ elements of treatment. Formal outcome studies of more typical psychoanalytic psychotherapy and of psychoanalysis itself begin to suggest that these long and complex treatments are effective in the more comprehensive ways predicted by the model.     

Mixed Race and the Negotiation of Racialized Selves: Developing the Capacity for Internal Conflict

The author uses contemporary psychoanalytic theory in further understanding the negotiation of conflict and dissociation in biracial patients who are both African-American and White. Drawing on the work of contemporary theorists who have made efforts to navigate the relationship between inner and outer worlds in our understanding of race from a psychoanalytic perspective, the author examines the relationship between race, culture, and internalized self-other relations—how they interact with each other and impact splitting and dissociative processes among self-states. The author argues for a notion of the unconscious as one that contains historical trauma related to race relations that influences the developing capacity to sustain internal conflict between opposing self-states borne out of this trauma. The author shows how society works against the integration of racialized self-states and interferes with the capacity to contain conflict. Through an extended clinical vignette from an analysis of a mixed-race patient, the author looks at the interplay of self-states between a White analyst (author) and a mixed-race patient (African-American and White) as manifested through a series of enactments and the unconscious “mating” between dissociated self-states in both patient and analyst. The author argues that the analyst's engagement of his or her own dissociated self-states and containment of internal conflict is critical to aiding the patient in moving toward greater integration.     

Recent developments in the technical approaches of English-language psychoanalytic schools

This paper summarizes developments in the major approaches to psychoanalytic technique derived from the ego psychology, Kleinian, British independent, self psychology, intersubjectivist, and interpersonal schools over the past fifty years. The author proposes that two major contemporary currents may be differentiated from each other, namely, the psychoanalytic "mainstream"--derived from contemporary Kleinian, contemporary Freudian, and British independent sources, and the "intersubjectivist-interpersonal-self psychology" current. In significant contrast to these two major currents within the English-language psychoanalytic approaches, the French psychoanalytic school has evolved a unique third approach to analytic technique. The author proposes that these three currents constitute the dominant trends regarding technique in contemporary psychoanalytic practice. The paper concludes with a brief outline of the characteristics of each of these technical approaches.     

SEXUAL ABERRATION OR INSTINCTUAL VICISSITUDE? REVISITING FREUD'S “THE SEXUAL ABERRATIONS”

The author reconsiders Freud's “The Sexual Aberrations,” the first of his Three Essays on the Theory of Sexuality (1905), in light of contemporary psychoanalytic theory. Are the concepts of sexual aberration and norm still viable? The author argues that they are necessary but insufficient elements in current theory. He then presents a competing model in which sexuality can be reduced to a more elemental level of disturbance and wish, where it is an expression of a nonsexual wish—for example, to possess or control the object to eliminate separateness. The author presents clinical material to demonstrate this alternative model.     

Gender on the modern-postmodern and classical-relational divide: untangling history and epistemology

This essay considers the historical periodization and epistemology of psychoanalytic thinking about gender. Overlapping historically with feminism itself, psychoanalytic thinking about gender has two periods of efflorescence, the 1920s and 1930s, and the contemporary period beginning in the 1970s. Two divides have characterized our gender thinking, the modern-postmodern and the classical-relational. From the early theorizing of the 1920s and 1930s until around the early 1990s, most psychoanalytic thinking about gender should be considered modernist, as it draws on traditional views of scientific evidence and holds more universalistic and dichotomized conceptions of men and women. In the contemporary period, although postmodernism tends to be associated with relational psychoanalysts and modernist thinking with classical analysts, the divisions overlap. The author argues that considering any psychoanalytic theory as "premodern" is misleading: from its inception, psychoanalysis formed part of modernism.     

Some reflections on the use and meaning of conflict in contemporary psychoanalysis

The author reflects on the concept of conflict in contemporary psychoanalysis, and especially in European psychoanalysis. In the latter, this concept does not seem to have aroused significant interest. This does not necessarily mean that conflict has been rejected or replaced; rather, there has been a greater focus on preconflictual stages of development. Indeed, conflict is generally implicit in psychoanalytic work, and, like many other concepts, it has very different and at times divergent meanings, both in various psychoanalytic schools of thought and within the same school. The author presents a clinical example to illustrate some of the possible choices of the analyst at work concerning the use of the concept of conflict.     

The Analytic Principle and Attitude: Mobilizing Psychoanalytic Knowledge to Maximize Social Work Students' Practice Competence

Although psychoanalytic approaches have been marginalized in the foundations of contemporary clinical social work practice, there are core themes in various psychoanalytic theories that can be made accessible to maximize students’ practice competence. We elucidate the psychoanalytic principle of unconsciousness as well as the analytic attitude of inquisitive listening and its components. Using vignettes, we demonstrate how we teach this attitude in bachelor's in social work (BSW) and master's in social work (MSW) classrooms. This approach can help students begin to think and listen psychoanalytically. It offers them a way to better understand the person beyond the symptoms.     

Finding the Lost Girls: Multiplicity and Dissociation in the Treatment of Addictions

Relational perspectives on the nature of self and the unconscious have transformed how we can understand addictions and substance use problems. Addictions have received little attention in the contemporary literature and therapeutic approaches outside of psychoanalysis have been skeptical of psychoanalytic approaches. It is my contention that viewing substance use problems through the lens of a relational/multiple self-state model offers new clinical possibilities resulting in greater success in treating these patients. In this model, addictive behavior is seen as embedded in dissociated self-states. Therapy focuses on helping the patient to move from dissociation to a true multiplicity and a decreased dependence on substances.     

A Plea for a Measure of Cautious Optimism: Reply to Book Reviews

The author responds to four reviews of his book Impossible Training. He describes how the book came into being, discusses his attitude to the Freud—Ferenczi and Klein—Winnicott debates, and raises the dangers of rigid views as to what is truly psychoanalytic and what is truly relational. The global scene of psychoanalytic training today is discussed. It is suggested that critiques do have an impact on psychoanalytic education and that in spite of its flaws and inner contradictions, this education raised generations of sophisticated thinkers and sensitive clinicians.     

Innen, Außen, Zwischen

The so-called “intersubjective turn” (or “relational turn”) in psychoanalysis is closely associated with the work of Winnicott. It was him who added a new dimension to the psychoanalytic theories of a separate inner world, a dimension focussing on the mediating processes between the separate spheres of psychic and external reality: a space between subject and object, drive and civilisation, Ego and reality — the “potential space” that unconsciously connects our self to the Other as well as to a shared physical and social world we live in. Winnicotts paradoxical notions of the self are traced in this paper and unwrapped from their often enigmatic, developmentally and epistemologically confusing veils: the infant who does not exist without a holding mother; who is not aware of his/her being held because of its evidence, and only has an experience when falling; who him-/herself creates that reality which is already there; who must destroy the object in order to use it; who can only be alone when another person is present. The author, starting from apparently narcissistic phenomena of the media society, rehabilitates the term of “in-between” in contemporary psychoanalytic discussion which for a long time was considered as suspect, as being part of a “non-psychoanalytic” superficial social psychology (as the intersubjective, the interpersonal or the interactive). Under the strong influence of Winnicott, and overarching the different schools, contemporary psychoanalysis is focussing on intersubjectivity and relationality. The paper is an appeal for reformulating classical intrapsychic concepts — including the theory of the unconscious—in intersubjective terms, thus unfolding a relational approach inherent in Freud’s metapsychology.     

The condition of affects and aspirations in adult depression

A commentary by a noted television anchorman in the book ON THE EDGE OF DARKNESS about this depression contains familiar themes. These will be cited, followed by a consideration of traditional psychoanalytic theories of depression. Broadening the contemporary theoretical domain, self-psychology provides useful understandings of how narcissistic aspirations along with failed childhood affect attunement become central features of depression. Treatment implications are considered along with an application of theory to a pastoral counseling case. Such a case demonstrates the role and interplay of religious ideation, emergent narcissistic aspirations and affects as they relate to a client's depression.The author dedicates this article to Terry Lyon, Diplomate, A.A.P.C., who was a sustaining presence during a crucial phase of my self-searching and awakening. The author also wishes to express appreciation for the counsel of Wes Brun and colleagues at the Samaritan Counseling Center.     

Neue Entwicklungen in der allgemeinen psychoanalytischen Psychosomatik

Psychoanalysis has played a pivotal role for developments in psychosomatics both on a conceptual and an institutionalization level. In contemporary psychosomatics there is a focus on conceptual models that concentrate on psychic structure, the processing of emotions and embodiment. Alongside these, the questions arise on how psychoanalytic views on psychosomatic disorders in a more classical sense will develop further and their relevance for current developments. This article gives a brief historical overview of some central concepts in psychoanalytic psychosomatics and shows how these are resumed in what can be distinguished as six aspects of contemporary psychoanalytic psychosomatics. This is demonstrated by a brief case report. The article closes with some proposals for the clinical practice.     

MUTUALITY AND ONE-SIDEDNESS IN KJELL ASKILDSEN'S THE DOGS OF THESSALONIKI: THE PSYCHOLOGY OF EVERYDAY LIFE

The aim of this paper is to bring to the fore how a talented writer is able to describe everyday human relationships in a way that makes visible their most central, underlying dynamics. After reviewing some of the psychoanalytic literature, the author presents a collection of short stories by the Norwegian author, Kjell Askildsen. These works illustrate how the fear of incest, sado-masochistic, exhibitionistic, and addictive defenses can play the rôle of “directors” of human dramas. Askildsen, with relentless accuracy, decribes a longing for reciprocity and defences against it. In such a conflict, reciprocity is felt dangerous and only momentarily fulfilled, and defences are necessary.     

THE DISSOCIATIVE TURN IN PSYCHOANALYSIS

In his response to the Roundtable Discussions on what is effective in psychoanalytic psychotherapy, the author focuses on the renewed interest in the concept of dissociation that began to emerge toward the end of the 20th century. A contemporary psychoanalytic position informed by the impact of developmental trauma has led to an understanding of and interest in the dissociative mind. The actuality of trauma during infancy and early childhood is recognized as a key factor leading to the emergence of dissociative processes, the potential dissociative structuring of the mind, and mind being characterized by multiple, discontinuous, centers of consciousness. The therapeutic goal in the psychoanalytic work with fragmented patients is to establish communication and understanding between the dissociated self-states. The author offers two brief clinical examples of working with dissociated self-states.     

The so-called rule of abstinence revisited

The paper discusses whether the rule of abstinence is still valid in the contemporary theoretical arena of psychoanalysis. Not only is this a debate on principle. It also raises the question of how gratifying the analyst should be in the analytic encounter, still remaining within the psychoanalytic paradigm. Current criticisms of the concept of abstinence are reviewed. The author replies to the objections. He argues that the so-called rule of abstinence is not a “rule” which describes the particular behaviour of the analyst, but a general principle describing the essence of the psychoanalytic cure. In the opinion of the author, abandoning this principle may have detrimental consequences both theoretically and technically. Finally, the author discusses the emotional presence of the analyst in the analytic setting and suggests an updated version of the idea of analytic abstinence.     

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.     

BECOMING RELATED: THE EDUCATION OF A PSYCHOANALYST

The author uses a “professional memoir,” a story about his first experiences in clinical work, to illustrate what he believes to be certain fundamental aspects of an analytic attitude. Taking place in a psychiatric hospital, it is meant to highlight the central place of intuition, emotional receptivity, empathy, relatedness—and their inherent dangers—in engaging therapeutically with patients' emotional disturbances. The author postulates that these and related aspects of clinical psychoanalysis are not sufficiently emphasized in psychoanalytic training and are often eclipsed by idealizations of psychoanalytic theories and their derivative techniques, third‐party demands for evidence‐based data, preoccupations with neurobiological correlates of experience, etc. Despite the clinical fact that psychoanalysis can be extraordinarily helpful to patients, he questions whether clinical psychoanalysis is rightly regarded as a “treatment.”     

Learning from women with psychosis

The article describes psychoanalytic reflections in the work of a consultant psychiatrist responsible for a recently developed female intensive care unit. The manifestations of aggression were observed to be different from that of male patients. The behavioural manifestation of aggression by women was linked to the themes of secrets, and of hidden aggression, which are described in the analytic literature as feminine characteristics. The relationships between women as sibling inpatients and with female staff may explain some of the difficulties in managing aggression. Hidden aggression in the dyad of female-to-female transferences and countertransference may contribute to problems in all female inpatient settings. Bringing together the themes of psychosis and of women from a psychoanalytic perspective, the author suggests that the care pathway leading to transfer to the intensive care unit may exacerbate psychotic symptoms in acute states, due to specific vulnerabilities of women. The provision of specialized inpatient services for women may be more therapeutic if female development and the nature of their relationships were better understood.     

Sullivan und die intersubjektive Sichtweise

The author sees H.S. Sullivan??s (1892?C1949) interpersonal theory as the best theoretical framework for the contemporary intersubjective perspective in psychoanalysis and presents it in its pluridimensional articulation. After having extended Freud??s therapeutic approach to psychotic patients, Sullivan developed both a developmental psychology and a psychoanalytic and psychotherapeutic technique based on the ??interpersonal field?? as the basic unit of study. To the pluridimensional character of his theory also belongs its application to the cultural and social aspects of our personal identity. Because the contemporary psychoanalytic authors who shaped the intersubjective perspective limited themselves to the clinical dimension, Sullivan??s interpersonal theory can still provide the theoretical framework which any psychoanalytic perspective needs.