Beyond the Psychosexual: The Body–Mind Relationship Discussion of “Somatic Experiencing”

The author discusses the importance of focusing on the body in analytic work since it functions as an important springboard for the patient to discover his or her unique existence. It also helps develop a dialogue between the mind and the body’s sensory level. This is a more archaic domain than the more often emphasized psychoanalytic tradition of organizing our thinking psychosexually. The author also underscores the differences between psychoanalysis and Somatic Experiencing and the risks and advantages of modulating or heightening sensory experience.     

Making “Use” of Aggression in Child Psychotherapy

In this article, informed by Winnicott's seminal 1969 article, “The Use of an Object and Relating Through Identifications,” I aim to illuminate the transformational possibilities that emerge when adults view particular forms of aggression as expressions of hope. I examine the processes associated with taking a child from what Winnicott referred to as object relating to object usage, with particular focus placed on the links between theory and practice. I highlight the importance of one mobilizing the social environment toward the attention of the child through limit setting while concurrently tolerating the child's aggressive acts by not retaliating or retreating. This shared relational journey involves helping a child move from the omnipotent but very lonely, anxiety-filled, encapsulated world of their own projections to a coconstituted reality and involves the child engaging in destructive activity (aggression) and the significant adult surviving. It is hope that underpins this destructive enterprise. When the child finally comes to realize that the other is not under their omnipotent control, that is, when the child has tried to destroy, and the other has survived, the child can then, and only then, forge a mutual partnership with the other. Conceptual points are illuminated through the presentation of case material.     

Making Music Together: Discussion of Gianni Nebbiosi’s “The Smell of Paper”

Finding life in our patients is a common goal for analysts. Historically this project had been defined as one of freeing unacceptable impulses from their imprisoning defenses with the analyst, via interpretation, then contrasting the patient’s internal fantasied reality with “actual” reality. Untangling fantasy from reality could free the impulses to provide energy for more realistic projects. This imagery stands in stark contrast to the fluidity of a contemporary relational conceptualization of human experience where our inner experience is now understood to be the lens through which we construct our vision of external reality, always a subjective perception. Clinical change—finding life—now depends more on the activation of a generative intersubjective process between patient and analyst, which contributes to the expansion of the patient’s subjective experience. Gianni Nebbiosi’s use of music and of mime to help him feel his way into his patient’s and ultimately into his own similarly defended experience demonstrates the creativity and idiosyncratic clinical approaches that emerge from a contemporary relational orientation. This orientation recognizes the analyst’s subjectivity as a fundamental tool of clinical change—a vehicle through which any theoretical approach will necessarily be shaped. Differing approaches to a clinical situation do not always simply reflect theoretical disagreements; they may also reflect the expression of the particular subjectivity of the analyst.     

Interweaving the Symbolic and Nonsymbolic in Therapeutic Action: Discussion of Gianni Nebbiosi’s “The Smell of Paper”

Gianni Nebbiosi’s paper speaks to therapeutic action in a new key in the challenges of finding communion with a hard-to-reach patient. He achieves this through the creative interweaving of the nonsymbolic, his mime and music, and the symbolic, which attains greater purchase through painful personal reckoning in concert with his increasing awareness of previously unformulated states within and between each member of this particular analytic dyad. Central to this paper is the move from an empathic stance to greater complexity for each of the dyad. Distinguishing between empathy and recognition is germane. Particularly as we witness the transformation through therapeutic action of empathic presence to recognizing presence that permits the emergence of a more complex empathy—an achieved empathy that incorporates feeling and knowing the multiple, more deeply held, and often paradoxical aspects of our patients and indeed of ourselves as these play out in intersubjective space.     

Discussion of “Vitalizing Enactment”

In this discussion of Amy Schwartz Cooney’s paper I heartily endorse her use of the ideas of Anne Alvarez, particularly as regards the vitalizing dimension of our clinical work with adults. I link these ideas with the current sea change in psychoanalysis about the need for theories addressing the ground level of contact making. I question the continued reliance on the concept of enactment and propose instead the establishment of a new language for working at this level, drawing on the writings of field theorists, infant–parent research, and child analytic work in the hope of discovering the medium that best captures the imagination and embodied and vital sensibility of our patients. I end by picking up on Cooney’s reference to necrotic zones and their relationship to “death equivalents” and what we may consider the life/death continuum.     

Discussion of “Melancholic Psychosis”

Derek Hook’s paper (this issue) represents an important discussion of the Lacanian perspective on melancholia and its close and often forgotten clinical link to psychosis. Hook’s paper provides a critical insight into how melancholia is understood as a surrender to the jouissance of the Other. The reviewer only disagrees with Hook’s idea that there is no object loss in melancholia because the melancholic knows whom he has lost but not what he has lost in the absent object. This unknown loss leaves him exposed to an erotogenic masochism proper and a self-annihilating kind of jouissance.     

“Living Memory”: Discussion of Avishai Margalit's “Nostalgia”

Avishai Margalit raises questions about how memory can be a moral and an ethical concern, and in this commentary on “Nostalgia,” Aron expands on these themes and examines the place of memory in psychoanalysis and in Judaism. The study of memory and of mind are inseparable. At its best, psychoanalysis does not contrast thoughts and actions, inner and outer, memory and motor action, intrapsychic mental life and interpersonal external behavior as simple dichotomous terms but rather views these as mutually defining transformations, different views of a single complex reality. Conceived in this way, memory is not a static internal picture, but rather is continually constructed, embedded in our interpersonal context. It is living memory.     

What Women Want: A Discussion of “Childless”

Rebecca Harrington’s “Childless” breaks the cultural and psychoanalytic silence about the idiosyncratic meanings of maternality—challenging our pronatalist assumptions. Following suit, this discussion questions our understanding of what women want. Freud was famously confounded by that question, and still, the psychological processes leading to decisions about motherhood are largely absent from psychoanalytic theory. Because of this, the heteronormative, socially agreed-upon dictum that women must be, and want to be, mothers remains locked in place. The conflation of feminine, woman, and motherhood serve to negate female subjectivity, limiting the possibilities for other creative pursuits. Contemporary psychoanalysis eschews the primary importance of instinctual drives yet has not challenged the notion of a maternal instinct that drives women to desire motherhood. The cultural and psychoanalytic silence about the complexities of reproduction and child-rearing has rendered individual women silent and their desires toward and away from motherhood unarticulated.     

“Das Ding”: Excessive Existence: Discussion of “Melancholic Psychosis”

Derek Hook’s (this issue) excellent paper provides illustrations of complex Lacanian concepts through the relatively rare presentation of Lacanian case material. His paper lends itself to reading Freud with Lacan. This reply to his paper engages such a reading to show that the idea of the over present object emphasised by Lacan is prefigured in Freud in his 1917 paper on Mourning and Melancholia. My reply to Hook affirms the additional clinical themes he introduces and indicates that these themes would be anticipated if, as Lacan argues, melancholia is seen to be underpinned by a psychotic structure. Finally, the reply argues for a resurrection of the Lacanian notion of Das Ding, as it connotes differently to objet a despite overlaps in meaning and the fact that in later Lacan the term Das Ding was dropped.     

“Why am I so stuck?”: A Collaborative/Therapeutic Assessment Case Discussion

Assessors from 3 continents worked together on a single multimethod case study. Their goal was to hold the client at the center and forefront of their attitudes and thinking as each assessor focused on a specific measure or group of measures. The adult client requested a neuropsychological assessment and completed a full battery of cognitive measures as well as the MMPI–2, the Rorschach, and the Wartegg. A basic tenet of collaborative/therapeutic assessment holds that the client is a full partner in the assessment process; he or she is also seen as the final arbiter of the usefulness of the ideas derived. With that in mind, the client worked with the lead assessor to create 6 questions she wished answered by the assessment. Feedback and discussion occurred in a number of ways: through discussion sessions with the lead assessor that included extended inquiry; individualized letters from the other assessors, each addressing her 6 questions; a summary letter from the lead assessor; and a metaphorical, therapeutic story that stressed key findings from the assessment. Results converged powerfully, with similar findings from each assessor. The client stated that she felt heard and understood in the process, even by individuals who she had never met personally.     

A Review of: “Making Sense of Ourselves and Others”

Midpoint ratings of elements on personal constructs have been given various interpretations, and the placement of the ideal self at the midpoint of a construct has been viewed as violating Kelly's (1955) Kelly, G. A. 1955. The psychology of personal constructs, Vol. 2, New York: Norton. Reprinted by Routledge, 1991) [Google Scholar] dichotomy and choice corollaries. This article reports analyses, using a mixed models approach, of repertory grids completed by 80 clients referred to a clinical psychology service at up to five assessment points both pre- and posttherapy. A larger than expected number of ideal self ratings at the midpoint was found, and consideration of the content of several of the constructs concerned elucidated why it might have been that neither pole was preferred. Midpoint ratings of the ideal self increased over the course of therapy and were not associated with depression or anxiety. Midpoint ratings of the ideal self and self now were also related to various structural measures of construing. Theoretical and clinical implications of the findings are discussed.     

Discussion of Slade “Imagining Fear”

This discussion addresses the importance of fear as a key feature of attachment, examining some of the implications of Slade’s argument both for clinical work and for understanding of developmental process. The discussion also is focused on the kinds of genetic and evolutionary theories most useful in thinking about interactive effects, namely epigenetics, the study of genes in context. Finally the discussion identifies relational theory, which focuses on fear as an implicit dimension of attachment. Bromberg’s work on dissociation is cited as an example of work in which fear plays a prominent role.     

Making sense of “the inevitable”

Theoretical Medicine and Bioethics -     

Clinical Scenarios of “Remembering”: Somatic States as a Process of Emerging Memory

This paper explores the relationship between somatic states and nonverbal processes of memory, and suggests an intervention model favoring the exploration of these states when they emerge during an analytic session. Somatic states and symptoms are considered here to belong to the enactment process, which is part of the web of Self-with-Other relational procedures and of the subsymbolic procedural or implicit mode of knowledge, inherent to and necessary for the development of subjective and relational skills and an integrated sense of Self. The analytic dyad can agree to consider somatic states as a sort of dream of the body that, like a dream of the mind, can be explored and investigated together. In the clinical experience presented, a painful somatic state gives shape to a significant enactment. By focusing perceptive attention on the somatic state, it reveals the memory of a traumatic experience. The integration of the dissociated memory overcomes the impasse that the analytic relationship is experiencing as the conclusion of the therapeutic process draws near.     

Discussion of “Bread and Roses: Empathy and Recognition”

Rachel Kabasakalian McKay’s (this issue) important contribution focuses on a comparison of “empathy” and “recognition.” In her paper, McKay compares the sensibility of responsive attunement that she associates with empathy to the sensibility of distinctiveness that she connects to recognition. This discussion takes up this comparison of empathy and recognition associated with their embeddedness in self-psychology in contrast to relational and intersubjectivity theories. In the author’s view, the essential tension between autonomy and at-one-ness is necessary to both empathy and recognition and should not be split between them. Because recognition is Benjamin’s fundamental idea, the foundation of intersubjective recognition theory, it is incumbent on us to develop and elaborate the precise technical meanings, denotations, and connotations of this term, along with its clinical and social implications. The author believes that the key to this project is to see that, for Benjamin, recognition occurs throughout life across developmental levels and thus actually refers to quite different, although deeply related, phenomena.     

The magical number seven: Making a “bit” of “sense”

The maximum number of categories distinguishable in making an absolute judgment was estimated by Miller to be “seven plus or minus two,” corresponding to about 3 bits of information transmitted per stimulus. Later work extended this range to include at least 2 to 4 bits of information, which reached 16 categories. In contrast, the number of distinguishable differences between two stimuli is in the order of 100. Why is this so? It is shown here that an answer to these questions can be obtained by constructing anentropy function, Hs, which is a measure of the uncertainty of a subject (or a sensory receptor) as it perceives the magnitude of an applied stimulus. Using this function, it is demonstrated that the ubiquitous 3 bits of information per stimulus can be approximated from the expression \(\log _2 \sqrt {{{\tau _2 } \mathord{\left/ {\vphantom {{\tau _2 } {\tau _1 }}} \right. \kern-0em} {\tau _1 }}} \) , where τ₁ and τ₂ are known time constants. The same entropy function can be used to derive various other psychophysical laws, such as the Weber-Fechner law, Stevens’ law, and the Bunsen-Roscoe law.     

Discussion of “Three Dimensional Field Theory”

Ringstrom addresses major changes in a number of paradigms that have been occurring over the past 50 to 70 years within the larger scientific/philosophical community and, more specifically, within psychoanalysis. His overall purpose is to further delineate and integrate these paradigmatic changes and their theoretical and clinical implications for understanding psychoanalytic change. In his title, “Three Dimensional Field Theory: Dramatization and Improvisation in a Psychoanalytic Theory of Change,” Ringstrom a third “spatial” dimension to relational field theory that makes it more than a metaphor. Dramatization and improvisation does not just refer to a technical approach but, more important, provides a framework by which he understands effective therapeutic interaction. This discussant attempts to evaluate several of the paradigm shifts, namely, the informational revolution and dramatization and improvisation.