Psychoanalytic Couple Therapy: Classical Style

In this essay, the core concepts of psychoanalysis are set forth as the context for the application of classical psychoanalytic theory to the practice of couple therapy. Infantile sexuality and aggression are shown to have a powerful role in the interpersonal lives of family members. The repetition compulsion structures marital interaction and intergenerational dynamics. The intrapsychic emphasis of classical ego-psychology is viewed in the interpersonal arena, and the author suggests adding to the Oedipus and Narcissus myths a myth that resonates with this shift in emphasis. In introducing the “Pygmalion–Galatea process,” the author captures the universal attempt to change the psychic dynamics of the other or others. This ultimately mutual process begins with the infant's mirroring of its caretakers—which includes language acquisition. Much of human interaction is fueled by subsequent attempts to create others in our own images of them and by their reactive compliance or resistance to that dynamic. Three case illustrations are presented to show how these phenomena manifest themselves in marital interaction and in dreams.     

An Independent Theory of Clinical Technique

The history of Independent analysis in the British Psychoanalytical Society is reviewed. The Independent Tradition, as an approach to psychoanalysis, is distinguished from the organisational grouping in the British Society that is the Independent Group. The Independent Tradition emphasises what differentiates human beings rather than how they exemplify general principles. This derives from Freud through Ferenczi. Ferenczi's stress on the quality of the patient's experience, on the need for analysts to be aware of the effect on themselves of the analytic process, and on the need for restraint in interpretation are all characteristically Independent aspects of analytic technique. Later Independent thinkers have developed these themes further. Especially important is Enid Balint's idea that theory mediates the analyst's creative imagination. The analytic setting infuses ordinary human interaction with psychoanalytic awareness, and another function of theory is to imbue with psychoanalytic understanding the use of everyday language. Independent clinical technique is primarily a way of listening. Regression is accepted, and free association valued as being in itself a vehicle of psychic growth. A central idea is that the analyst is an analytic object to be made use of by the patient. Several clinical examples illustrate the functioning in practice of these concepts.     

The role of support in psychoanalysis.

A two-factor theory of clinical psychoanalysis is proposed. In accordance with the predominant position of the structural-adaptational ("classical") approach in psychoanalytic theory, the power of interpretation and insight in clinical psychoanalysis has received ample attention in psychoanalytic literature. There seems, however, to be a growing awareness among analysts that not all the facts of an analytic treatment can be accounted for by this approach alone. A second factor is increasingly recognized: the power of adequate support provided by the analyst and resulting in a specific experience by the analysand. In the application of the developmental ("postclassical") approach of psychoanalytic theory, the importance of this support-experience factor in the treatment of ordinary neurosis by means of ordinary psychoanalysis is emphasized. The relative neglect of this aspect of clinical psychoanalysis may be indicative of the present-day dilemma of how to translate advances in theoretical knowledge of mental development into the therapeutic praxis of psychoanalysis. There may, however, be another important reason. Support and experience are phenomena often occurring on the nonverbal level. In contrast to interpretation and insight, they are usually not voiced, let alone distinctly and loudly expressed. They are the silent power of psychoanalysis.     

The Task of the Translator

This discussion reflects closely on Dominique Scarfone’s call to consider psychoanalysis as a practice founded on ethics, and to rely on this premise in charting a fundamental common ground such that has eluded psychoanalysis for most of its history. Out of the three points Scarfone centers on, I dedicate most attention to the third—psychoanalysis as modeled on the notion of translation—because I find his suggestion inspiring, and promising toward the goals he sets for his paper. Building on the basis Scarfone offers in this context with the help of ideas developed by Walter Benjamin and Emmanuel Levinas, I suggest that the vision that can pull us together as psychoanalysts indeed relies on an ethics of attending to the other’s speech, its meaning as well as its fundamental yet complicated striving for comunicability. More specifically, we need to recognize that words can hide our need to say them. That what we say obscures our vulnerability and shame. That when we try to recall, the language we speak is distorted by the personal and historical forces collaborating to make us forget ourselves. I argue that the task of the psychoanalytic translator is therefore to uncover and resignify the scattered, coded fragments; to help us restore our ability to tell our stories; and to recognize that more than everything, we want to tell them.     

Against Limited Foreknowledge

Theological fatalists contend that if God knows everything, then no human action is free, and that since God does know everything, no human action is free. One reply to such arguments that has become popular recently— a way favored by William Hasker and Peter van Inwagen—agrees that if God knows everything, no human action is free. The distinctive response of these philosophers is simply to say that therefore God does not know everything. On this view, what the fatalist arguments in fact bring out is that it was logically impossible for God to have known the truths about what we would freely do in the future. And this is no defect in God’s knowledge, for infallible foreknowledge of such truths is a logical impossibility. It has commonly been assumed that this position constitutes an explanation of where the fatalist argument goes wrong. My first goal is to argue that any such assumption has in fact been a mistake; Hasker and van Inwagen have in effect said only that something does go wrong with the argument, but they have not explained what goes wrong with it. Once we see this result, we’ll see, I think, that they need such an account—and that no such account has in fact been provided. The second goal of this paper is therefore to develop— and to criticize— what seems to be the most promising such account they might offer. As I see it, this account will in fact highlight in an intuitively compelling new way what many regard to be the view’s chief liability, namely, that the truths about the future which God is said not to know will now appear even more clearly (and problematically)‘ungrounded’.     

Psychoanalysis as science

This work explores two “Copernican shifts” in the history of psychoanalysis. The first is Freud's recognition of the motives behind the constructions of psychic reality; the intrusion of the wish in the subject's perceptions. The author explores the roots of this recognition in the scientific tradition of Kant and Helmholtz, and suggests that these two predecessors were topical for Freud in their deviation from a theory of “immaculate perception”. The other theme of this work is what the author suggests is a contemporaneous “Copernican shift” in psychoanalytic theory. This shift consists in a recognition of the topicalness of the experience of reciprocity. Connections between this experience and the experience of the self are described, and implications for the theory of the psychoanalytic process are suggested.     

Seeing,mirroring, desiring: The impact of the analyst’s pregnant body on the patient’s body image

The paper explores the impact of the analyst’s pregnant body on the course of two analyses, a young man, and a young woman, specifically focusing on how each patient’s visual perception and affective experience of being with the analyst’s pregnant body affected their own body image and subjective experience of their body. The pre‐verbal or ‘subsymbolic’ material evoked in the analyses contributed to a greater understanding of the patients’ developmental experiences in infancy and adolescence, which had resulted in both carrying a profoundly distorted body image into adulthood. The analyst’s pregnancy offered a therapeutic window in which a shift in the patient’s body image could be initiated. Clinical material is presented in detail with reference to the psychoanalytic literature on the pregnant analyst, and that of the development of the body image, particularly focusing on the role of visual communication and the face. The author proposes a theory of psychic change, drawing on Bucci’s multiple code theory, in which the patients’ unconscious or ‘subsymbolic’ awareness of her pregnancy, which were manifest in their bodily responses, feeling states and dreams, as well as in the analyst s countertransference, could gradually be verbalized and understood within the transference. Thus visual perception, or ‘external seeing’, could gradually become ‘internal seeing’, or insight into unconscious phantasies, leading to a shift in the patients internal object world towards a less persecutory state and more realistic appraisal of their body image.     

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.     

„Das Auge ist’s, was die Taten verwandelt. Das neugeborene Auge verwandelt die alte Tat“

A few Leitmotifs of a lifetime dedicated to psychoanalytic work are presented: The a priori assumption of psychoanalysis is that everything psychical — whether in patients or in ourselves, in culture and society, or in the religions — can preferentially be understood as expression of conflict and complementarity: that everything in inner life may best be studied as struggle between opposites and of how these polarities gradually complement each other. Almost everything can become acceptable if it is being interpreted as conflict. This has to happen in very specific and concrete terms, for psychoanalysis is the art of the specific. The universally valid is scientifically very important, but in clinical work it remains empty unless filled with specific experiential content. The antithesis between inner and external reality, between subjectivity and objectivity, between understanding and explaining, determines all psychoanalytic discourse. A modern version of this antithesis pits the narrative character of how we work with our patients and report about this work, against the ever increasing pressure to express everything in numbers, in diagrams, in percentages — i.e., the tension between the qualitative and the quantitative, between the time flow of the biography (its narration) and the timelessness of what is counted. Another Leitmotif is the basic attitude and motto of “exploring instead of judging”, entailing the systematic superego analysis, especially the work on the superego transference. An important element of problematic, even noxious countertransference is the therapist’s acting out of a superego attitude, e.g. in form of confrontative (“drive oriented”) interpretations that are experienced by the patient as reproach. A cliché contradicted by experience is that of the almost exclusive value of transference interpretations. Clinical work shows that interpretations outside the transference may also be of great help and importance; in particular, the exploration of issues in current relationships outside of treatment may have an emotional urgency that may make them ideal for recognition and working through of unconscious conflicts. The central question always remains: What do we best focus upon if we want to bring the unconscious conflicts closer to resolution.     

Reclaiming the Boundary Concept from Forensic Discourse: Response to Commentaries

The author argues that sexual misconduct is better referred to as ethical or sexual misconduct rather than combining a fragile metaphoric construct—boundary—with forensic jargon. His argument rests on a few points that intersect. One objection to the term “boundary violation” involves a matter of scale in which the notion of exploring psychic boundaries, the essential context for psychoanalysis, is obliterated by sexual misconduct. The enormous scale of sexual misconduct is better labeled with behavioral referents rather than a moniker that combines forensic violation and the subtleties of analytic process. The author would reserve the term boundary difficulties for analytic process related to more subtle problems in analysis and the use of boundaries embedded in the work. Another objection relates to our responsibility to those outside our community to refrain from using our sophisticated understanding of the play of boundaries in analytic work in ways that are too often unintentionally confusing and mystifying.     

Emotional turbulence during the ending of psychotherapy with an anorexic adolescent

In this paper I reflect on the phase of the analytic process which precedes the termination of a psychoanalysis and describe my work with an adolescent girl. Adolescents with serious eating disorders relive in a particularly violent way, in the final phase of their analysis, the catastrophic anxiety of separation and the fear of annihilation connected with this. The perception of the final date, felt to be irrevocable, reactivates in these patients the psychotic part of their personality, which tries through a phantasy of omnipotent possession (expressed through pathological projective identification) to obscure the reality of separateness and loss. It is useful with these patients to set a date for ending at least a year in advance to enable the working through of these psychotic anxieties. Clinical material illustrates how in the final year of treatment all phases of the analytic process are relived in a violent way, and how this emotional turbulence manifests id as a battle between omnipotent phantasy and an increasing insight into psychic reality.     

THE WILDE ANALYST

Oscar Wilde (1854–1900) took on the challenge of teaching us how to live artfully. From the dynamic successes and tragedies of his own life Oscar knew that everything worthy of existence is worthy of art, including its ugliness and suffering. Oscar observed much about human nature, especially his own, in an era when convention was not challenged, knowledge was taught and appearances were everything. For him, “The supreme vice is shallowness.” Society and psychoanalysis can still be honored and shaken by his words. The paradoxical and complex nature of Oscar's insights was as good as any coming from a thoughtful psychoanalyst. After the first two attempts to write about Oscar fell flat, it became clear that I must engage with him and try to match the unsparing commitment to explore his unconscious and interior life. In the process of creating the array of sketches of my psychoanalytic encounters with Oscar, I also found the words to describe what drew me to the field some 20 years ago—the art of psychoanalysis.     

Thinking Developmentally in Child and Adult Psychoanalysis

Psychoanalysis in theory and clinical practice is a developmental domain. Psychoanalysts think about their patients from a developmental point of view. The analytic relationship promotes development in both analyst and patient. Two concepts central to this author’s developmental point of view are epigenetics—as used in biology and philosophy—and that of the analyst as “developmental object.” Optimally, the analyst as developmental object facilitates what Rita Tähkä terms the “developmental illusion,” which intersubjectively transforms psychic structures, enabling alternatives to the repetition compulsion. Two vignettes with adult patients illustrate how empathic intimacy in psychoanalysis with an emphasis on latency and toddler phases as reconstructed in adult analysis presaged psychic growth. Transference as a vehicle for a developmental history taking is also considered.     

Individual differences in verbal conditioning, extinction, and awareness

The present study examined the relationship of three individual difference variables—need for approval, a belief in internal versus external control of reinforcement, and verbal intelligence— to acquisition, extinction, and awareness in a verbal conditioning task Based on a postexperiment interview and recognition task, subjects were grouped according to their awareness of the response-reinforcement contingencies and the degree to which they admitted influence by the experimenter Approval motivated subjects were more likely to acquire the reinforced response regardless of awareness levels than were low need for approval subjects. Subjects assessed as internal were more likely to deny influence by the experimenter and in some instances were more resistant to extinction than subjects called external Subjects higher in verbal intelligence evidenced more awareness than subjects with lower intelligence scores Results suggest that the inclusion of individual difference variable is of crucial importance to a clear understanding of the experimenter-subject interaction in the verbal conditioning situation Implications for the other dyadic interactions, particularly psychotherapy, were discussed     

Interestingness—A Neglected Variable in Discourse Processing

Symptomatic of a contemporary concern with affective factors in cognitive processing, a corpus of research is now emerging on the role of interestingness in discourse processing. This research has concentrated on narrative prose and has adopted a structural approach, arguing for the centrality of event and discourse structure in producing an affect like interest. The authors point out that this approach considers only one type of interest—knowledge-triggered—to the exclusion of another important type—value-triggered. A more comprehensive understanding of interest will only be achieved by researching other genres, such as exposition, and by considering the multiple sources of interest-producing conditions. We suggest the notion of “informational significance” as an inclusive term, and underline the need for a process-based understanding of interest.     

The therapeutic action of psychoanalysis

Psychoanalysis does not seek to get rid of symptoms but to question them as witnesses of psychic functioning and as formations of the unconscious. Whatever their nature may be, it is a question of analysing their causes and their functions as they appear and develop during the course of the analytic process. The latter is activated by the transference relationship induced by the method within a specific setting. The aim is to bring about liberating psychic transformations. The extension of the indications and modifications in the expression of psychic suffering have led to the development of psychotherapies. Their relations with psychoanalysis proper have been evolving constantly since the first advances by Ferenczi. This long historical evolution has resulted in their redefinition. Psychoanalytic practices are currently considered to require, depending on the case, different settings and different modes of psychic involvement from the analyst. Contemporary psychoanalysis places emphasis on the internal setting of the analyst (thus his training), analysis of the countertransference, and the risk of anti-analytic aberrations.     

ATTENTION AND MENTAL PAINT1

Much of recent philosophy of perception is oriented towards accounting for the phenomenal character of perception—what it is like to perceive—in a non‐mentalistic way—that is, without appealing to mental objects or mental qualities. In opposition to such views, I claim that the phenomenal character of perception of a red round object cannot be explained by or reduced to direct awareness of the object, its redness and roundness—or representation of such objects and qualities. Qualities of perception that are not captured by what one is directly aware of or by representational content are instances of what Gilbert Harman has called “mental paint” ( Block, 1990 ; Harman, 1990 ). The claim of this paper is that empirical facts about attention point in the direction of mental paint. The argument starts with the claim (later modified) that when one moves one's attention around a scene while keeping one's eyes fixed, the phenomenology of perception can change in ways that do not reflect which qualities of objects one is directly aware of or the way the world is represented to be. These changes in the phenomenology of perception cannot be accounted for in terms of awareness of or representation of the focus of attention because they manifest themselves in experience as differences in apparent contrast, apparent color saturation, apparent size, apparent speed, apparent time of occurrence and other appearances. There is a way of coping with these phenomena in terms of vague contents, but vague contents cannot save direct realism or representationism because the kind of vagueness required clashes wth the phenomenology itself.     

The Father-Daughter Relationship in Sigrid Undset's Writings

In every psychoanalysis, there is a contradiction between an eternal and a limited time perspective as regards the analytic task. This corresponds to the contradictory relationship existing between the unconscious, which is timeless, and the linear time of external reality. On the basis of these conditions, this paper describes how the experience of time in different ways is significant for analytical understanding and how it influences the analytic work. Various phenomena related to time and the perception of time are illustrated by clinical vignettes. The difficulties in handling the time limit are discussed from both a theoretical and a practical point of view. At the termination of a psychoanalysis, the two time perspectives meet. This presents opportunities for insight and change as well as a special challenge to both the analysand and the analyst.     

Dreams in Child Psychoanalysis

More than six decades after Freud's death, psychoanalysts are certainly not more unified in their view of the concept of the unconscious—its structure and its way of working—than in ‘the good old days’. Challenges are facing psychoanalysis from many perspectives, urging psychoanalysts to continuously reconsider their theoretical grounds. This paper pursues three lines of argumentation concerning the Unconscious. The first line concerns the relation to neuroscience and this paper suggests the concept of background feelings (Damasio) as a contribution to another understanding of deficits in the psychoanalytic relationship. The second line concerns the relation to cognitive semiotics, and here, the paper stresses the concept of basic image sehemata as a possible link between the subject's pre-reflective awareness of the other and the internal world of phantasy. The third line pursues a concept of the analytic interpretation which is close to the Freudian idea that psychoanalysis is the communication between two Unconscious, and, consequently, that the psycho-analytic interpretation is not per se a conscious act.