Book reviews

Wilfred Bion is regarded as a psychoanalytic purist and his austere portrayal of the analytic aim and attitude is often considered to make impossible demands on patient and analyst alike. Not surprisingly, the applicability of Bion's theory and recommended practice to once-weekly psychotherapeutic work is often questioned. Bion is thus ambivalently regarded by psychotherapists as the embodiment of an analytic ideal, whose developmental theories are important, but whose practical utility is doubted, especially in the context of the typical therapeutic setting. This paper seeks to challenge these assumptions by presenting the once-weekly therapy of a woman with attenuated mentalizing capacity and a tendency to destructive acting out. The therapy was guided by the application of central concepts, models and ‘technical’ principles emerging from my understanding of Bion's work. The aim of the paper is to demonstrate that Bion's utility is not confined to formal psychoanalytic settings and that his work may be usefully applied in more modest psychotherapy contexts.     

Process‐orientated psychoanalytic work in initial interviews and the importance of the opening scene

From the very first moment of the initial interview to the end of a long course of psychoanalysis, the unconscious exchange between analysand and analyst, and the analysis of the relationship between transference and countertransference, are at the heart of psychoanalytic work. Drawing on initial interviews with a psychosomatically and depressively ill student, a psychoanalytic understanding of initial encounters is worked out. The opening scene of the first interview already condenses the central psychopathology – a clinging to the primary object because it was never securely experienced as present by the patient. The author outlines the development of some psychoanalytic theories concerning the initial interview and demonstrates their specific importance as background knowledge for the clinical situation in the following domains: the ‘diagnostic position’, the ‘therapeutic position’, the ‘opening scene’, the ‘countertransference’ and the ‘analyst's free‐floating introspectiveness’. More recent investigations refer to ‘process qualities’ of the analytic relationship, such as ‘synchronization’ and ‘self‐efficacy’. The latter seeks to describe after how much time between the interview sessions constructive or destructive inner processes gain ground in the patient and what significance this may have for the decision about the treatment that follows. All these factors combined can lead to establishing a differential process‐orientated indication that also takes account of the fact that being confronted with the fear of unconscious processes of exchange is specific to the psychoanalytic profession.     

The Frame,Within and Without: Discussion of “The Therapeutics of the Fee in Psychoanalysis”

The author picks up and expands on themes of fusion and separation brought up in Pauley’s discussion of the therapeutic uses of the fee in the psychoanalytic encounter. She asserts that the elemental nature of the exchange of goods speaks to us in the language of corporeal experience, making it a powerful disruptive force that can reshuffle defenses at the level of our most primary experiencing selves. This affords the fee the potential to reach us in the registers of sensation and enactment that bypass conscious, verbal communication making our authentic and ongoing attempts to grapple with it vital to the analytic project.     

Reflections on the setting in the treatment of adolescents1

The author focuses on the signifi cance of the setting for the development of the psychoanalytic process, especially in the case of adolescents who request analytic treatment. Her main goals are to specify: a) how the setting is confi gured with this type of patients; and b) to what extent it contributes to the creation of an inner space that may internalize a fi gure with reverie‐a good object that will metabolize the bad and thus enable identifi cation. The setting, which is considered the necessary context for analytic work, is defi ned as bearing two facets: that of the analyst, which must be constant and stable, and that of the adolescent, which will progressively change provided that the analyst maintains a fi rm context that contributes to make the adolescent feel contained and accepted. It is such a feeling that will enable the unfolding of the analytic process. The author emphasizes the importance of the presence of the analyst (his or her voice, the manner of his or her speech, and so on), and the need for the analyst to comply with the rules he or she has established together with the patient. She presents a clinical case to illustrate this conceptualization.     

MARION MILNER, MYSTICISM AND PSYCHOANALYSIS

It is unusual to combine mysticism and psychoanalysis. Marion Milner, however, achieved precisely this. Through her self-analysis and analytic work with children and adults—and using as an illustration her own and others' imaginative ideas, paintings, doodles, drawings and pictures—she drew attention to the potential for health and creativity of undoing the obstacles to mystical experience of oneness with what is beyond or other than the self, which she sometimes called God, the unconscious or the id. This article seeks to explain and highlight this aspect of her contribution to, and continuing importance for, psychoanalytic theory and practice—particularly that associated with Winnicott—through detailing her early life and diary-keeping experiments, some of her psychoanalytic case histories during and after the Second World War, her work as an artist, ending with her travels and her involvement during the 1980s and 1990s with the Squiggle Foundation and British Association of Art Therapists.     

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.     

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.     

Black client,white therapist: Working with race in psychoanalytic psychotherapy in South Africa

In post‐apartheid South Africa we speak about race extensively. It permeates our workplace, weaves a thread through the fabric of our professional and personal lives, as well as our private conversations and public interactions with others. From within psychoanalytic theory, the thread weaves through the unknown content of our racialized unconscious. When there is a focus on race in the South African psychoanalytic context it largely takes the form of the struggle to articulate the complexities of working with difference, as Swartz notes, or the struggle to map out issues of race. Such struggles are not localized in South Africa, but strongly reflect a much broader struggle within the global psychoanalytic community, as mirrored in the expanding focus on race. Although the consulting rooms seem far removed from the ongoing political tensions that have recently emerged in South Africa, psychoanalytic psychotherapy remains a space of meaningful engagement with the other, and where the therapeutic dyad is one of racial difference it permits an encounter with our racialized unconscious. This article seeks to document the experience of my black client and my white response to her racial pain and struggle; in doing so, I describe the racial ‘contact’ between us and within us that triggers a racialized transference and countertransference dynamic, which contains the space for racial healing for both of us.     

“Expanding the Frame”: Reply to Commentary

In responding to a discussion by Susi Federici-Nebbiosi of “When the Frame Doesn't Fit the Picture,” I further consider the ways in which analysts and analysands together create the best conditions for their work. I emphasize that analytic work best fulfills its potential when it grows out of a collaborative search for ways of constructing the psychoanalytic situation that are most fully and subtly responsive to the unique qualities and circumstances of each patient and analyst. Implications for psychoanalytic training of an intersubjective model of frame construction are briefly considered.     

A contemporary integration of modern and postmodern trends in psychoanalysis

Postmodernism has appeared on the psychoanalytic horizon and with it brought change and some confusion. Although many link or even conflate it with relational and intersubjectivity theory, those views are as subject to a postmodernist critique as other analytic orientations. Postmodernism can also be seen as usefully informing the concepts of psychoanalytic narrative and psychoanalytic space. It should not be viewed as an organized theory or movement that would entirely replace modernist ideas in psychoanalysis. Indeed, valid critiques of both modern and postmodern psychoanalytic positions have been advanced. In this climate the need for a viable integration remains urgent. Bruno Latour's development of the concept of hybrid structure as a way of dealing with the same kind of impasse in the field of science studies is presented, along with its applicability to the dilemma faced by psychoanalysis.     

Slips of the analyst.

Understanding the analyst's work and its vicissitudes has been a major focus of recent psychoanalytic writing. This study on slips of the analyst represents an attempt to advance our understanding of analytic work. The slips described support the view that slips reflect not simply contributions from instinctual life, but active work-related goals of the analyst in carrying out the analytic tasks. Countertransference is discussed as reflected in the disturbance of intentionality betrayed by the occurrence of a slip. The essential role of the analyst's understanding his or her own reactions is emphasized.     

Reflections on creative aspects of psychoanalytic diagnosing

This paper explores the therapeutic value of considering psychoanalytic diagnoses as co-constructions, and emphasizes two interrelated points: First, there are distinctions between medical, psychiatric, and psychoanalytic diagnoses, and similarly, a distinction may be drawn between diagnoses as nouns and the activity of diagnosing. Second, the author stresses that psychoanalytic diagnoses are theory bound. Various competing theories facilitate or interfere with the maintenance of an optimal analytic attitude. Some theories facilitate an analyst's urge to engage in the activity of diagnosing, which may reflect a destructive countertransference enactment. Analytic data in support of these premises is presented and discussed.     

The analytic surface and the theory of technique

This paper examines the concept of the analytic surface as a starting point for the interpretive process in relation to the theory of psychoanalytic technique. The history of the concept of the analytic surface within psychoanalysis is reviewed. Four different conceptualizations of analytic surfaces are described (M.M. Gill, P. Gray, A. Kris, E.A. Schwaber). The advantages of a "surface" approach are explored in relation to clinical work, the teaching of psychoanalytic technique, and opportunities for research. Some criticisms of the concept are explored.     

Toward a psychoanalytic iconography

In describing the principles of psychoanalytic iconography, I follow a historical approach, pointing out that the rudiments of such an interpretive mode are present in Freud's works on Leonardo and on the Moses of Michelangelo and reach a classical expression in Kris's paper on Messerschmidt. Some recent scholarly studies of works of art rest on the incorporation of psychoanalysis into contemporary views of the nature of man, thus permitting a level of analysis of art not previously attained. The interface between a psychoanalytic understanding of the artist's life and preoccupations and the unconscious content present in the work itself continues to offer an opportunity for refining the analytic tool as an instrument for understanding aesthetic response and creativity.     

A genuinely developmental theory of sexual enjoyment and its implications for psychoanalytic technique

A small computer-assisted word frequency analysis, indicating the extent of explicit concern with sexuality in the psychoanalytic literature, has revealed an apparent decline of psychoanalytic interest in psychosexuality. The apparent decline may be related to the limitations of drive theory and object relations approaches in offering persuasive and comprehensive accounts of the psychosexual. A new model of human sexual experience is proposed, rooted in an integration of French psychoanalytic ideas with recent developmental observational research, that once again places sexuality at the center of psychoanalytic clinical inquiry. Because emotion regulation arises out of the mirroring of affect by a primary caregiver and sexual feelings are unique in that they are systematically ignored and left unmirrored by caregivers, sexual feelings remain fundamentally dysregulated in all of us. Adult sexual experience serves as a way of coming to organize the psychosexual. The model accounts for some aspects of the phenomenology of sexual arousal and suggests ways of understanding pathological distortions of sexual behavior. The nature of the psychosexual is explored in the analytic treatment of an adolescent boy.     

Toward a tripartite vision of supervision for psychoanalysis and psychoanalytic psychotherapies: alliance, transference-countertransference configuration, and real relationship

The psychoanalytic supervision relationship is examined as a tripartite phenomenon, comprised of the supervisory alliance, transference-countertransference configuration, and real relationship. While most supervisory analysts would readily acknowledge that a real (or personal) relationship element exists in analytic supervision, that facet of the supervision relationship has not routinely been incorporated into considerations of psychoanalytic supervision. In this vision of supervision, real relationship, supervisory alliance, and transference-countertransference configuration are presented as integral and complementary constructs that define psychoanalytic supervision. Each of those three components is examined briefly with regard to its beginnings, evolution, and contemporary status; each component is also considered from an empirical perspective. While we have a growing quantitative and qualitative research foundation that supports psychoanalytic practice, psychoanalytic supervision has largely been ignored as a subject and object of scientific study. Supervisory alliance, transference-countertransference configuration, and real relationship are explored as research ready variables. Some clinical hypotheses--eminently testable and worthy of investigation--are proposed with regard to each component of the model, and some ideas--albeit tentative and preliminary--about how to initiate such inquiries are offered.     

Psychoanalysts' multiple relational perspectives

The specific contribution of the person of the analyst--his or her attitudes, fantasies, and entire range of emotional responses to the patient--have become the subject of much investigation in psychoanalytic literature. This paper describes the phenomenon of distinct and sometimes contradictory self-experiences in analysts that develop as part of the moment-to-moment process of a predominantly adaptive coping mechanism. It is suggested that at any given point, the analyst's perspectives (reflecting various self-states), like those of the patient, are multiple, and that the analyst "choose" to place one such perspective at the center of experience. By choosing a certain self-state, the analyst can adopt, for example, a warm and loving stance with a regressed and demanding patient, or become harsh (e.g., setting boundaries, ending a session) with one who seeks affection and protection. This paper also suggests that the capacity to move between versions of self-states, to see them as complementary even when they are paradoxical, promotes a deeper understanding of paradoxes in the personality of the patient. Only when the analyst maintains a dialogue between various dissociated aspects of his or her analytic experience can a dialogue of this kind begin in the patient.