Psychoanalysis and the university: a difficult relationship

A critique of present-day isolation of psychoanalytic institutes and of their lack of emphasis on research and scientific development is followed with concrete proposals for reorienting psychoanalytic education toward university settings, with the ultimate purpose of bringing together psychoanalytic theory and scientific contributions with the contemporary contributions of neurobiological science and the humanities. Efforts already under way in this direction and practical recommendations for further steps to integrate psychoanalytic education and research within university settings are outlined.     

The enduring Rorschach contributions of David Rapaport

David Rapaport's contributions to the Rorschach are highlighted and placed within the context of his significant impact on psychological testing and psychoanalytic theory. After a brief biographical sketch, I examine the essence of Rapaport's lasting Rorschach contributions and summarize some of the strengths and limitations of the Rapaport Method.     

Values,Consciousness, and Language

Two seminal thinkers, Edelman and Damasio, offer neurophysiological models of brain development and functioning that correspond with a contemporary psychoanalytic focus on dynamic experiential intersubjective systems. I describe their respective contributions under three headings derived from Edelman: values, consciousness, and language. I consider the scope of each of these topics as it abuts related psychoanalytic concepts.     

Psychoanalysis, marital therapy, and object-relations theory

This paper attempts to indicate why psychoanalysts should be interested in marital therapy. It discusses the clinical advantages and disadvantages of marital therapy as compared to psychoanalysis, describes the contributions of the classical psychoanalytic viewpoint to marital therapy, and finally, attempts to complement the classical psychoanalytic viewpoint with an object-relations viewpoint which can illuminate marital dynamics and provide interpretive content during the course of marital therapy.     

Emptiness in agoraphobia patients

In light of new research findings about the efficacy of psychodynamic treatment for panic disorder and agoraphobia, it seems a prudent time to carefully address psychoanalytic thinking about the treatment of agoraphobia. The literature has highlighted oedipal contributions to its genesis and clinical unraveling in psychoanalysis. While those contributions are indeed central to the disorder, structural deficits in the self-representation often become a central focus of treatment once symptomatic remission has been achieved in psychoanalytic treatment. This aspect of the clinical presentation of agoraphobia has not yet been specifically addressed in the psychiatric literature. Some aspects of the phenomenon have been described by psychoanalysts. It is more difficult to treat this "emptiness" than the overt symptoms of agoraphobia, as described in DSM-IV. Nonetheless, this phenomenon may be one of the contributors to the chronicity of the disorder. Two clinical cases illustrate these points.     

The Therapeutics of the Fee in Psychoanalysis

This paper seeks to provide context for the fee and its varied meanings in the ordinary workings of psychoanalytic treatment. Drawing in particular on the contributions of D.W. Winnicott, it sets out a framework for approaching the topics of fee-setting, raising and reduction, and seeks to account for the difficulties that ensue when practitioners accept fees or allow debts that are out of sync with their personal needs for monetary compensation. It argues that the integrating rituals around fee payment, indispensable as they are to the material foundations of psychoanalytic practice, are also intrinsic to the vitality of analytic relationship as a therapeutic system or “analytic third.”     

Reflections on Freud's Dora Case After 48 Years

I revisit Freud's case of Dora from the vantage point of current literary and psychoanalytic perspectives. Mahony (this issue) argues that Freud's understanding of Dora is unconvincing to the modern reader because Dora is a victim of trauma rather than sexual repression. I extend Mahony's ideas in terms of the development of psychoanalytic ideas, place Freud's view in the context of my psychoanalytic education in the mid-20th century, and suggest that modern contributions to trauma theory and memory further support the thesis that Dora was a victim of trauma rather than of conflicted libidinal desires.     

Revision from the Margins: Fromm's Contributions to Psychoanalysis

Fromm's important contributions to the modern development of psychoanalytic thought are often ignored and frequently misunderstood. An early proponent of revisions of psychoanalytic theory and therapy similar to recent trends in object relations, self-psychology and interpersonal psychoanalysis, Fromm was a visionary for a Freudian theory built upon orthodoxies of the past but going beyond them. It is argued here that Fromm's unique role in helping create a new version of psychoanalysis for the 21st century was as sociological as it was intellectual. Fromm's contributions were intimately linked to his institutional positioning close to the center but on the relative margins of the discipline. This paper will outline how sociological dynamics shaped Fromm's revision of psychoanalysis. We will conclude by discussing how Fromm was able to have a more dramatic influence than other Freudian revisionists who were less favourably positioned.     

The components of psychic conflict and its consequences in mental life.

This paper surveys current psychoanalytic concepts of drives, unpleasure related to drives, defense and compromise formation, with special attention to the author's contributions to each subject during the years 1950-1978.     

Narcissism: origin and goal of the ego. Reflections of Lou Andreas-Salomé

The author presents Andreas-Salomé's theoretically relevant, though largely neglected writings. She devoted special interest to narcissism. Her contributions to this topic are discussed in relation to Freud's corresponding texts, with whom she maintained an enduring friendship. General reference is made to the more recent psychoanalytic debate about narcissism.     

The construction of the gendered self

Feminist contributions to systemic approaches to human behaviour have led to gender being defined in interactional terms. Gender is seen not as a fixed quality or trait but as one socially constructed between men and women. This idea is discussed in relation to the gender debate in family therapy, attachment theory and feminist contributions to psychoanalytic thinking. Gender relationships are created as part of a person's internal working models of self and other. The ways in which gender patterns are carried forward are examined, especially with respect to the contradictions between a person's gendered internal working models and their experience. These ideas are explored through case examples.     

Culturally Imposed Trauma: The Sleeping Dog Has Awakened. Will Psychoanalysis Take Heed?

This paper considers the scant attention psychoanalysis gives to cultural trauma. Three contributions to this deficiency are considered: (a) the continuing identification with our psychoanalytic forefathers’ silence regarding cultural trauma, (b) the authoritarian practices in psychoanalytic institutions that keep us overly focused on standard intrapsychic formulations to the near exclusion of cultural trauma, and (c) the fact that work with cultural trauma is difficult. To do this work requires us to “buck the system.” If we do so, we expose ourselves to toxic phenomena in a world still rife with cultural trauma. This paper, which includes clinical vignettes, is an invitation to do so.     

Getting Home: A Discussion of “Accompaniment in Jazz and Psychoanalysis”

Situating his current paper (this issue) within the developing dialogue between psychoanalysis and music, as well as within the evolution of Markman’s own definitive contributions to that dialogue, this discussion identifies Markman’s inspired, embodied musicality as the primary force animating Markman’s writing and clinical work. Markman’s remarkable taxonomy of rhythmic styles of psychoanalytic accompaniment, formed entirely by his clinical experience, is highlighted and elaborated. The value of music as a source of metaphor is contrasted with an understanding of the actuality of music as a dimension of psychical life that is cultivated and healed through psychoanalytic accompaniment. Using “process notes” from a music documentary, the power of actual music is located in the fabric of culture, conducted through musical sound and forms of movement, including the rhythmic practice of the psychoanalytic frame and the antiphonic discourse of psychoanalytic process.     

Minding the gap between positivism and hermeneutics in psychoanalytic research

Two quite different cultures are to be found within psychoanalysis, one more clinical in orientation, more focused on meaning and interpretation, and relying primarily on the traditional case study method, the other more research-oriented, focused on cause-and-effect relationships, and relying primarily on methods borrowed from the natural and social sciences. The history of this divide is reviewed and arguments, pro and con, about the potential contributions of specific types of empirical investigation are discussed. Increasingly, it seems, criticisms concerning the scientific status of psychoanalysis are being responded to by empirical research. This has contributed to a growing recognition within the scientific community of the credibility of aspects of psychoanalytic theories and of the effectiveness of psychodynamic treatment. However, some segments of the psychoanalytic community are concerned that this increase in the quantity and quality of empirical research on psychoanalytic concepts risks creating an empirical one-sidedness, while other segments are concerned that not engaging in systematic empirical research can lead to intellectual isolation, fragmentation, stagnation, and orthodoxy. To counter this polarizing tendency, a recommendation is made for methodological pluralism. Adopting this stance could contribute to an enriched understanding of the clinical process and to the development of new research methodologies to investigate complex psychodynamic hypotheses, thus bridging the gap between the two psychoanalytic cultures, as well as the gap between research and clinical practice.     

The mind: psychoanalytic understanding then and now

The author discusses the evolution of psychoanalytic understanding from Freud's time to the present, citing the influence of various sociocultural changes. He addresses Freud's proper place in history and notes ways in which Freud's contributions cast him as belonging to Romanticism. Freud's shift from the topographic model of the mind to the structural one, and the influence of this on psychoanalysis, is discussed, as well as important developments in the field since Freud. The author focuses particularly on difficulties encountered in psychoanalytic practice today, and he describes what he has termed organizing interpretations as uniquely valuable in the treatment setting.     

Becoming (and Remaining) an Analyst in Latin America

The following overview of the development of psychoanalysis in Brazil and in Porto Alegre outlines the current situation and the challenges to psychoanalysis in my country. I will explain my own experiences on becoming an analyst, the main reasons for my choice, my main influences, and my evolution as a clinical psychoanalyst and as a member of psychoanalytic and psychiatric institutions. I include my main contributions to psychoanalysis and consider two broad areas of interest: psychoanalytic technique and its teaching, and the relationship of psychoanalysis and culture. As for the former, my main interests are studies on countertransference and analytic neutrality, to which I will propose a comprehensive concept. As for the latter, I discuss a culture that contrasts vividly with the one in which Freud created the discipline, psychoanalytic views on violence and perversity, psychoanalytic institutions, and the application of analytic ideas for the understanding of some artists and their work.

I will also describe some general features of my country and the development of psychoanalysis in it; report my experiences as a candidate and an analyst; and offer some information about my evolution as an analyst through papers I have written over the past 30 years.     

What can we learn from psychoanalysis and prospective studies about chemically dependent patients?

Despite the common occurrence of drug abusers in the psychoanalytic clinic, contemporary literature on the subject, particularly among publications in the IJP, is sparse. This paper aims to review the most important psychoanalytic contributions on drug dependency in the past 100 years, then attempts to compare their postulations to the findings ofpertinent prospective studies. In these patients, a persistent symbiotic object relationship is found, which ties them to narcissistic functioning, where drug use is viewed in the light of both pleasure without object and omnipotently controlled need. The author also discusses the possible contribution of the mother and father in the genesis of this condition, focusing on the compromise of the paternal function as the deciding factor. The theoretical and technical implications of this approach are illustrated by clinical material.