Immoral Bodies: The Implicit Association Between Moral Discourse and the Body

Three studies examined the ways in which cognitive appraisals of health and the condition of the body use moral discourse derived from Christianity. Study 1 indicated that people explicitly rated health-related behaviors such as exercising and dieting as more pious and less sinful than their negative counterparts. Studies 2 and 3 elaborated upon these results using the Implicit Association Test, a cognitive procedure for examining automatic (or implicit) associations that may exist outside of conscious awareness. Results indicated that people have a strong implicit association between morality and the condition of the body. Furthermore, this implicit association remained significant once potential overlap with standard evaluative terminology was statistically controlled. These results suggest that people implicitly evaluate the condition of the body using moral discourse, and that the use of such rhetoric reflects the cognitive appraisal of obesity as immoral, rather than as simply negative in a standard sense.     

Psychoanalytic identity and the external world: Interaction between psychoanalysis and health service systems in Sweden

Abstract

This paper continues the exploration of the clinical phenomenon of analytic contact. The author demonstrates, through case material, the essential ingredients of psychoanalysis to be not frequency or use of the couch, but rather the moment-to-moment analysis of the patient's transference state and phantasies of what it means to establish relational contact with their objects and with themselves. The nature of the treatment can be shaped, prevented, perverted, or fostered by the patient's phantasies and unconscious conflicts into something more analytic or less analytic. Interpretation needs to include the exploration of the patient's attempts to change the treatment into something that is often a replica or a repetition of archaic object relations. The typical patient in psychoanalytic treatment is struggling with rather profound pathology and as such tends to create a significant stand-off with the analyst when analytic contact is forming. Analytic contact is often threatening to these patients in very primitive and alarming ways that must be gradually understood and interpreted if the treatment is to survive and remain a primarily analytic journey rather than be transformed into a more supportive counseling or a pathological re-enactment of conflictual phantasy states.     

EXPLICATING THE IMPLICIT: THE LOCAL LEVEL AND THE MICROPROCESS OF CHANGE IN THE ANALYTIC SITUATION

This paper proposes a method of examining the micro-events of the analytic process that borrows heavily from developmental research. The increasing importance of illuminating the microprocess of interaction to understanding the process of change in analytic treatment is emphasised. A set of constructs and terminology is proposed for the study of the moment-to-moment interactive process in psychoanalytic therapy referred to as the local level. A theory of therapeutic action based on 'local-level' process is then explicated. Its central element involves a step-by-step process of 'fitting together', which leads to changes in implicit knowing through alteration of emotional procedures.     

Psychology and Culture: Back to the Future?

Psychology has a poor record in addressing cultural phenomena. One response is to turn to ancient concepts from local traditions and to use these as alternative analytic categories to explain behavior. However, there are problems with such an approach. These concepts will be read from the vantage point of the present and interpreted differently so as to propose different diagnoses (and solutions) for contemporary social problems. As an alternative, rather than using ancient resources as analytic categories in the explanation of behavior, we could instead examine how they are used as categories of practice as people actively make sense of their social context and themselves. Attending to such contemporary ‘lay’ usage (and the contestation it entails) allows for a more dynamic conception of cultural processes than is typical in psychology. More generally, I believe that it is possible to use our psychological constructs so that we can see the distinctive particularities of the phenomena before us in new and interesting ways, and in ways that respect their cultural specificity. This claim is illustrated through reference to recent work using the concept of social identity to illuminate aspects of Hindu pilgrimage.     

Pains and gains: a study of forced terminations

The forced termination of psychoanalysis, such as occurs when the analyst makes a geographic move, uniquely disrupts the analytic setting. This paper recounts the author's experience of terminating a full-time private practice of psychoanalysis and psychoanalytic therapy for such a move. The limited literature on the subject is reviewed with a focus on the use of technical variation in the forced termination situation. The author delineates three areas of interaction with patients where technical variation proved in her experience to be of value: dealing with countertransference and counter-reaction, providing information about the move, and the consideration and process of referral for continued therapy. As opposed to what would be predicted from a classical psychoanalytic perspective, the use of such technical maneuvers seemed to facilitate rather than impede analytic work. These variations in technique served at crucial times to maintain the analytic alliance, to preserve the patient's capacity to recognize and make use of transference, and to provide avenues for resolving past traumas in the transference and the actual loss of the analyst. The concept of the analyst as a new or useable object is proposed as providing a theoretical framework for understanding these observations.     

The explicit and implicit dance in psychoanalytic change

How the implicit/non-declarative and explicit/declarative cognitive domains interact is centrally important in the consideration of effecting change within the psychoanalytic arena. Stern et al. (1998) declare that long-lasting change occurs in the domain of implicit relational knowledge. In the view of this author, the implicit and explicit domains are intricately intertwined in an interactive dance within a psychoanalytic process. The author views that a spirit of inquiry (Lichtenberg, Lachmann & Fosshage 2002) serves as the foundation of the psychoanalytic process. Analyst and patient strive to explore, understand and communicate and, thereby, create a 'spirit' of interaction that contributes, through gradual incremental learning, to new implicit relational knowledge. This spirit, as part of the implicit relational interaction, is a cornerstone of the analytic relationship. The 'inquiry' more directly brings explicit/declarative processing to the foreground in the joint attempt to explore and understand. The spirit of inquiry in the psychoanalytic arena highlights both the autobiographical scenarios of the explicit memory system and the mental models of the implicit memory system as each contributes to a sense of self, other, and self with other. This process facilitates the extrication and suspension of the old models, so that new models based on current relational experience can be gradually integrated into both memory systems for lasting change.     

Reading Formations of Subjectivity: From Discourse to Psyche

This article represents a critical overview of strategies to examine subjectivity in discourse, highlighting a series of methodological approaches, which seek to manage the tension between discourse studies' focus on social and cultural structures, and psychoanalysis' interest in unconscious motivations. One aim is to trouble the supposed opposition between discourse analysis and the psychosocial approach and to regard the latter as a possible extension of insights established by the former. It is argued here that psychosocial readings in general, and Lacanian approaches more specifically, offer a cautious, nuanced way of introducing psychoanalytic ideas into the analysis of texts. The first part of this article offers examples of discourse analytic approaches, which have explicitly sought to incorporate psychoanalytic notions, followed by a discussion of Lacanian discourse analysis – a method shaped directly by this psychoanalytic school's concern with language. The article concludes with a series of methodological injunctions for conducting a psychosocial form of textual analysis.     

Patient-therapist match: revelation or resistance?

Patient-therapist match is a relatively new yet frequently invoked concept within psychoanalysis. Despite Freud's appreciation of the influence of the analyst's past to his or her work within the analytic setting, psychoanalysts have historically held varied opinions about the degree to which the analyst's personality and conflicts affect the analytic process. As analysis was reconfigured as a two-person system, attention focused on the fit between patient and analyst. The literature on patient-therapist match is reviewed, and the conclusion reached that this intuitively appealing concept suffers from a lack of rigorous definition and operationalization. Many authors invoke match in ways that imply that it is real, static, external to the domain of analytic inquiry, and unaffected by analytic process. In its present form, the concept of patient-therapist match obstructs rather than facilitates analytic exploration and obscures rather than clarifies what happens between analyst and analysand in psychoanalysis. By suggesting that match exists as a reality outside the domain of transference and countertransference, analysts may overlook the importance of psychoanalytic technique in creating a sense of match. Analysts may attribute stalemated or limited analyses to a bad match, rather than tenaciously exploring the transference-countertransference configurations that remain at the heart of analytic work.     

Narrative Derivatives of Alpha Elements: Clinical Implications

The author considers both the psychoanalytic field and the ways in which the characters of a psychoanalytic session can be understood. He then develops one of Bion's ideas, the dream in the waking state, by isolating the derivatives of such dreams or rather the alpha elements they consist of. The author implies a theory of technique which takes account of all the signals "the bi-personal field" gives the analyst about the functioning of the analytic couple by means of "narrative derivatives". This enables continual changes to be made in interpretation     

The analytic present in psychoanalytic reconstructions of the historical past.

The psychoanalytic reconstruction of specific influential past events has been a regular feature of psychoanalytic practice from its inception. More recently, as reconstructions of incestuous sexual abuse have become more frequent, the reconstructive process has attracted attention, and doubts have been expressed about the validity of the analytic evidence used to substantiate their inference. Over the years, psychoanalytic discourse about the adequacy of this evidence has moved from Freud's uneasy confidence to a rather sharply divided debate between advocates and skeptics. From beyond psychoanalysis, memory research raises questions about the validity of this evidence, and research on influence raises questions about the procedures by which it has been collected. A reexamination of several cases in which reconstructions emerged from unstable therapeutic circumstances leads to the conjecture that dynamics located in the analytic present may have been displaced to the historical past. Although logically "truth in the past" need not foreclose on "truth in the present," in practice, once a reconstruction surfaces, the latter seems to disappear behind the former.     

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.     

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.     

Turning aggression on the self: a study of psychoanalytic process

The concept of turning aggression on the self is studied, and some clinical vignettes are presented which demonstrate the use of this concept as a guide to the formation of an "ideal" for one kind of analytic intervention with one kind of analytic surface. Pertinent literature is reviewed, and assumptions implicit to the analyst's activity are discussed. This endeavor is viewed in the larger context of attempts to arrive at a clearer understanding of the psychoanalytic process.     

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.     

Reflections on knowledge and experience

As analysts become more experienced, theoretical knowledge becomes more integrated and implicit and is gradually transformed into the practical wisdom (phronesis) described by Aristotle. While this leads to greater freedom in ways of working, it remains conditional on the consistent disciplined practice represented by the analytic attitude. In the context of my own development as an analyst, I suggest that increasingly the analyst works from the self rather than the ego and link this with Fordham's account of ‘not knowing beforehand’. Some implications for boundaries, enactment and the use of personal disclosure are discussed in relation to clinical material. I compare analysis with the wisdom traditions of religious practice and suggest that analysis is concerned with a way of living rooted in humane values of compassion and benevolence.     

Introduction

Many clinicians interested in group and psychoanalytic thought have followed idiosyncratic and personally constructed modes of preparation. Formal training programs tend to differ in terms of emphasis on degree of previous analytic experience, quantity of supervision, number of courses, requirements to have personal analytic group therapy, as well as length of time required to lead an analytic group. The process of psychoanalytic clinical work seems to have been temporarily idealized but essentially resisted by long ingrained North American pragmatic and spiritual value systems. This has resulted in what has amounted to a 50 year flirtation, rather than identification, with Psychoanalysis by American professional culture. The depth of curative experience for patients and the intensity of clinical acumen for practitioners make an analytic perspective important to maintain.      

In the Name of Psychoanalysis: Persistent Controversies and Evolution in Psychoanalysis: A Review of Impossible Training: A Relational View of Psychoanalytic Education by Emanuel Berman

In his book Impossible Training, Emanuel Berman stresses the historical roots of current standards of psychoanalytic training and demonstrates the persistence of controversies that have been present in psychoanalysis and psychoanalytic training from their inception. This perspective, of psychoanalysis and psychoanalytic education as evolving, encourages candidates and practitioners to be participants and creative voices in an evolving field rather than rote followers learning a trade. The author proposes ways that the transference of educators to the younger generation of psychoanalysts can facilitate or interfere with the training of candidates. Berman is applauded for shedding light on current controversies in psychoanalytic education by showing their roots in historical controversies. However, the author points out Berman's tendency to overvalue his side of the controversy rather than embrace controversy itself as in the best interest of the evolution and development of the field.     

Better Identity Politics

Suchet's paper is an inspiring demonstration of the power of openness and vulnerability. It offers a clinically daring and theoretically far-reaching account of the transformation that can sometimes occur in the psychoanalytic relationship. My commentary focuses on two of the paper's major threads: the interplay of subjective experience, intersubjective space, and collective forces, and the ethical dimension of the psychoanalytic project. From the outset, the meeting between Ara and Suchet is not only a meeting of bodies and minds, but also a meeting of collective histories and politics. Suchet finds, and in her account powerfully demonstrates, that addressing her patient's trouble requires an exploration of how collective traumas and political narratives infuse the possibilities of intersubjective exchange and subjective meaning. In my commentary I trace and elaborate on the trajectory of this analytic process, contemplating the ways in which identities and identifications involve both familial and social attachments. I attempt to highlight Suchet's contribution to our understanding of how what happens, and is made meaningful, in the register of collective identification and experience, forms the very substance of subjective and intersubjective life, and should be therefore formulated as an intrinsic aspect of the analytic endeavour. Turning to Suchet's engagement with the philosophy of Emmanuel Levinas, I consider her drive to reach beyond the traditional boundaries of psychoanalytic discourse. Following the same drive, I add some ideas developed by Theodor Adorno, as means of illustrating the trouble and the potential for reconciliation inherent in the experience and politics of identity.