CONTAINING,TRANSLATING, AND INTERPRETIVE ACTING OUT

In analytic treatment, when patients project unspoken aspects of their internal self and object world, the analyst has to find ways to understand and communicate those expelled phantasies without the patient feeling accused, seduced, or persecuted; even when we do our best at interpreting such inner conflicts, the patient may experience our interpretations as assaults, forcing them to give up themselves or their hope for reconnecting with an object. The patient will resist or fight our efforts through the use of projective identification. Caught up in patient's projections, the analyst in turn may enact some of these phantasies by becoming the object rather than translating its presence in the transference, by overemphasizing one side over another of the patient's conflict, or by interpreting accurately but prematurely. These issues are illustrated in two case presentations and discussed in relation to the views of contemporary Kleinian writers on transference and countertransference.     

TRANSFERENCE BEFORE TRANSFERENCE

This paper is predominantly a clinical presentation that describes the transmigration of one patient's transference to another, with the analyst functioning as a sort of transponder. It involves an apparently accidental episode in which there was an unconscious intersection between two patients. The author's aim is to show how transference from one case may affect transference in another, a phenomenon the author calls transference before transference. The author believes that this idea may serve as a tool for understanding the unconscious work that takes place in the clinical situation. In a clinical example, the analyst finds himself caught up in an enactment involving two patients in which he becomes the medium of what happens in session.     

“Transferring” and transference

This paper is part of my research into psychotic transference and is also related to the psychotic aspect of any adult or infantile patient in analysis. In my research, I studied the origin of the concept of transference in Charcot's time before Freud, and the transformation of this concept in psychoanalysis. Freud thought that psychotic patients were not able to establish a transference relationship, but some of his early papers show the opposite. In fact, Freud himself and then several other analysts were able to develop a personal experience regarding the possibility of contact and transferring feelings and delusional experiences in a therapeutic context – individual, group, or institution. I provide some clinical examples in this paper, as well as some theoretical, personal views regarding intrapersonal and interpersonal transference. Like Freud and Melanie Klein, I believe that transference starts with life, but that in psychoanalysis it has a particular meaning.     

The Influence of Joseph Sandler's Work on Contemporary Psychoanalysis

This overview stresses Joseph Sandler's integration of classical ego psychology with contemporary object relations theory. As part of this integration, Sandler clarified the origins and internal structure of the superego as a consequence and development of the representational world. The representational world, in turn, derives from the internalization of significant self- and object representations in the context of affect activation as fundamental motivational factors. Sandler described the transformation of internalized object relations into an unconscious template, expressed in repetitive behavior patterns, and the reactivation of its constituent object relations in the transference. In differentiating the present and past unconscious in the transference, Sandler described the role responsiveness of the analyst in the psychoanalytic situation as a specific countertransference reaction that facilitates the analysis of the object relationships activated in the transference. Sandler also explored the relationship between affects and drives and the neuropsychological capacities represented by affective and cognitive developments that jointly determine the structural characteristics of the mental apparatus.     

The transference neurosis in Freud's writings

This paper reviews the evolution of the concept of transference neurosis in Freud's writings. It suggests that the language in which the concept of the transference neurosis is originally expressed by Freud includes an idea of the analyst as aggressively pursuing the analytic cure by waging a solitary battle against the patient's disease. With the representation of the death drive and the larger role accorded to sadism as its external manifestation in Freud's revised drive theory of 1920, the patient becomes the ally; resistance, in the sense of the conservative forces, not disease, in the sense of libidinal conflict, becomes the enemy. It is thus difficult to speak of a transference neurosis in the circumscribed way Freud originally meant it, and he ceased to use the term after 1926 rather than redefine it to fit his broader perspective. In this broader perspective, relative resolution of conflict replaced radical liberation of the patient from disease. That Freud did not redefine the term does not imply that he discarded it, or that we necessarily should. This paper suggests that Freud implied a functional distinction between transference as transforming agent and transference neurosis as result of that transformation. That distinction defines psychoanalytic cure in terms of the understanding of a symbolic transformation which is, through the transference neurosis, reexperienced as part of the psychoanalytic process.     

Permeability and Demarcation in the Psychoanalytic Process Functions of the Contact‐Barrier1

Introjection, identifi cation and projection are concepts that designate processes in which something is being put into or taken out of something else. These processes presuppose the overcoming of some form of separation between two entities. The permeability or impermeability of a fi ctive boundary between the representations of subject and object set the emotional tone of their coexistence. There are moments of complete diffusion, in which subject and object can no longer be differentiated, and moments of autistic enclosure in which the individual can no longer be reached at all. Permeability and demarcation result from the processing of stimuli carried out by the ‘contact‐barrier’, as an ego function. Stimuli of internal, libidinal or aggressive origin, as well as ‘im‐pressions’ of external origin, are classifi ed and processed with the aid of various kinds of factors arising from coagulated object‐relational experiences. Whereas for Freud the contact‐barrier regulates the quantity of energy and founds a topographical structure, Bion understands the contact‐barrier as a psychic function that simultaneously regulates boundary demarcation and making contact. In the psychoanalytic process, the contact‐barrier created by patient and analyst regulates the events in the transference and countertransference. An awareness of the struggle for contact and demarcation at the dynamic boundary representations that are constantly being recreated by both partners in the analytic process may be helpful in our clinical work. The author presents an examination of the ways in which patient and analyst make contact and demarcate the boundaries, which provides a better understanding of the dynamics of transference processes. He demonstrates this in relation to clinical material.     

'The healing power of love': The literary/analytic bond of marriage in Freud's essay on Gradiva

Freud 's declared position regarding the management of 'transference love' advocated 'abstinence', objectivity and even 'emotional coldness in the analyst'. However, his essay on Jensen's Gradiva reveals an identification with an involved and responsive 'maternal' analytic position associated with theorists such as Ferenczi, Balint and Winnicott. These theorists attribute the origins of transference love to the pre-oedipal stage, shaping their analytic model on the basis of the early relationship with the mother. Freud generally had difficulty identifying with such a position, since it entailed addressing his own inner feminine aspects. Yet a literary analysis of his 'Gradiva' reveals this stance in his textual performance, i.e. in the ways in which he reads and retells Jensen's story. Freud 's narration not only expresses identification with Zoe, the female protagonist, but also idealizes her 'therapeutic' conduct, which is closer in spirit to that of object-relations theorists. His subtext even implies, however unintended, that an ideal treatment of transference love culminates in a psychical 'marriage' bond between the analytic couple, a metaphor used by Winnicott to describe the essence of the mother–baby (analyst/patient) bond. Freud 's reading process is itself analogous to Zoe's 'therapeutic' conduct, in that both perform a creative and involved interaction with the text/patient.     

In-Between: Shapes of Subjectivities in the Analytic Situation

Starting from concepts that Winnicott developed and that are unexpectedly near to postmodern concepts, I attempt to map some features of the complex territory that lies between analyst and patient from the viewpoint of the relationship that exists between subjectivity and objectivity. In the first section, I give a personal reading of Winnicottian model, emphasizing the idea that the subject’s unconscious acts upon and transforms the object’s (thereby putting in motion further unconscious processes within the object). Then I highlight the presence, in the transference, of various levels of communication and of a paradoxical multidimensionality that upsets the traditional space-time categories and also upsets the analyst’s mental stance. In the third section, I present a new form of countertransference (pervasive), through which the patient’s unconscious creates a sensory environment of proto-emotions and atmospheres, of states and rhythms, that have permeated it and that, due to their intensity and nature, arrived there without symbolization. Finally, I attempt to demonstrate how the patient can undergo psychic change only if the analyst has, himself, inhabited an analogous process of transformation in response to the disturbances arising within the analytical relationship. The clinical-theoretical stance emerging from these reflections sees the relation to the other, to oneself, and to the world as made possible by subjective creation always taking place in the unconscious.     

Toward a definition of psychoanalytic neutrality

The word and concept of neutrality play an important but confusing role in the history of psychoanalysis. Does neutrality imply indifference? The origin of this ambiguity is traced to the fact that Freud himself never used the word "neutrality" (Neutralitaet) in his own writings. (His term Indifferenz was translated as "neutrality" by Strachey.) The essence of the controversy that has simmered in the psychoanalytic literature ever since is contained in the question: "Is remaining true to the concept of neutrality somehow antithetical to the analyst's genuine involvement with the patient?" In this paper, I examine the feeling and power aspects of the word and suggest that the concept of neutrality becomes clinically useful when the analyst asks himself the question, "Neutral to what?" The analyst's awareness of his motives for recognizing and addressing certain conflicts and for overlooking others is heightened. With three clinical vignettes as illustrations, I explore the role of the concept of neutrality in deepening our understanding of (1) the analytic relationship; (2) The influence, on the conduct of the treatment, of the analyst's goals and theoretical persuasion regarding how the goals are to be achieved. As examples, I use the current debates over the relative value of the analyst's focusing his attention on: (a) the patient's mind in the hour rather than his life outside the hour and, (b) transference over nontransference interpretation. Finally, I emphasize the far-reaching implications of adding an explicit concept of "external reality" to A. Freud's exclusively intrapsychic definition of the "objective" analyst's position of neutrality as equidistant from id, ego, and superego. The addition of this fourth point to the analyst's "compass" widens the analytic field toward which the analyst is neutral. The concept of neutrality with respect to specifiable conflicts is thereby also broadened to include (a) interpersonal conflict within the psychoanalytic relationship and (b) conflict within the analyst. With these explicit additions, the concept of neutrality with respect to conflict becomes congruent with the current emphasis on the nonauthoritarian two-persons aspects of the psychoanalytic relationship, without detracting from the primary analytic goal of deeper understanding of intrapsychic conflict.     

The role of the patient's remembered history and unconscious past in the evolution of Betty Joseph's 'Here and now' clinical technique (1959-1989)

The author historicizes one aspect of Betty Joseph's ongoing technical contributions in terms of its originating London kleinian context. Early on she drew upon both the patient's remembered history and unconscious past, linking these experiences in past-to-present transference interpretations in order to effect psychic change. In evolving the technique of 'here and now' analysis, Joseph came to emphasize a communicative definition of projective and introjective identification as well as the significance of enactments while marginalizing the use of part-object anatomical interpretative language. She gradually set aside directly linking the patient's past with the present, compelled now by making direct contact with her patients. She now tracked how difficult patients acted in and responded to interpretations from moment to moment. The author maintains that the explicit and implicit conceptual work of Wilfred Bion as well as Joseph's continuous group workshop for analysts led to an increased understanding of the patient's projective impact on the analyst's countertransference responses, and thereby increased the analyst's capacity with 'difficult to treat' narcissistic spectrum patients described by her colleague, Herbert Rosenfeld. In recent work, while Joseph continues to elucidate what patients recall about their early past, she formats her understanding in terms of a direct analysis of the structure of the patient's projected internal object relations in the transference. The analyst works with the patient's communications and enactments, with a greater emphasis on a more 'inside-to-outside' understanding of transference in contrast to the earlier 'past-to-present' work associated with both Freud and Klein. This investigation concludes with one example of Betty Joseph's significant impact on contemporary kleinian technique by taking up some of Michael Feldman's work. Now the analyst listens to the 'past presented,' the patient's projected internal world, as well as tracks how the patient hears and subtly mishears interpretations for defensive, equilibrium-maintaining purposes, as the analyst attempts to effect psychic change by widening the ego's perceiving functions.     

Finding the depressed object in the obsessional: a clinical study

In this paper the author explores the clinical significance of the presence of a depressed internal object in a patient with marked obsessional features, dominating the patient's internal world and restricting relations in external life. After discussing important aspects of the contribution of Freud and later writers to the study of obsessional neurosis, the author provides clinical material that shows the patient's tormented relationship to a feared depressed object that was manifested in the transference. Developing her argument, the author suggests that if the analyst does not fully grasp the primitive anxieties of the underlying state of mind she can be prone to enter into an aggressive enactment with the patient's sadistic superego. This kind of enactment may arouse excitement and triumph in the patient, but actually confirms his doubts and fears about the capacity of his object to contain him.     

The Dawning of a Thought and the Role of Play and Trauma

A critical scrutiny of Freud's case the Rat Man elucidates the implications of the built-in contradictions that Freud made while evolving the psychoanalytic method. By comparing the published case of the Rat Man with Freud's private notes we get access to two different perspectives. Wishing to mould a clinical situation that would confirm his theories and uphold the image of the psychoanalyst as an authority figure, Freud was partly blind to some irrational distortions in how he perceived the interaction between the patient and himself. Contradictory explicit and unconscious “theories” and the emergence of a more modern understanding of transference, which includes inter-subjective dimensions, are expounded.     

Impervious and intrusive: The impenetrable object in transference and countertransference

The author describes an internal object that he calls the ‘impenetrable object’ which has two characteristics: being impervious to the projections from the patient and being intrusive, i.e. projecting into the patient. It arises out of an early relationship with a mother who may be generally disturbed or traumatized so that she is unable to take in or tolerate the child's projections and may use the child as a receptacle for her own projections. He links the concept of an impenetrable object with other concepts such as Williams's ‘reversal of the container–contained relationship’ and Green's ‘dead mother’. If such an object dominates the patient's internal world, it can lead to severe difficulties in the analytic process. Interpretations may be experienced as violent projections from the analyst which the patient has to ward off and the analyst may enact an impervious or intrusive object in various ways. The author describes a case in which such dynamics played a significant role. He argues that intensive work in the countertransference is required to detect subtle enactments and allow a shift in the analyst, which in turn can enable change in the patient. He gives clinical material that demonstrates such work by the analyst and illustrates the shift from an impenetrable object to a more permeable one in the patient's internal world.     

Self-analysis: a fool for a patient?

In this paper I first reviewed the scanty publications on the subject of self-analysis. Although it was recommended by Freud as early as 1910 for every analyst, self-analysis turns out to have many pitfalls and to be quite a complicated and controversial procedure. There is no agreement on the proper technique of self-analysis in the literature, nor is there any discussion of the determinants of the particular choice of technique of self-analysis that is employed, nor even of the reasons why some analysts do not engage in it at all. Using clinical data gathered from written material of many years of self-analysis following the termination of a successful training psychoanalysis, I have attempted to elucidate some of the problems posed by this procedure. These problems are in some ways similar to formal psychoanalysis, but are in some ways contingent on the fact that it is basically a different technique. It is a solitary occupation and therefore suffers from the dangers of disintegration into autism, narcissism, and obsessional rumination. There is no living presence of an analyst to serve either as a transference figure or to make interpretations and stimulate the production of material. The identification with the analyst's analyzing function is far from simple in self-analysis because of the complex nature of the various internalizations of the analyst that take place over years of a formal training analysis. Thus, Ticho (1967) is correct when she claimed that self-analysis is a skill that the analysand has to acquire by himself or herself. An important phase of the beginning of self-analysis involves the working through of the separation from the psychoanalyst and the re-evaluation of the analyst and the analytic process. This results in a heightened sense of independence and autonomy, increased cohesion of the self, and maturation--which is manifested by greater autonomous ego functioning, a more mature sense of identity, and continued transformations of narcissism which highly valuable goals, on the basis of the data I have presented, can be approached through the process of self-analysis. Above all this stands the most important goal of self-analysis, the understanding of one's countertransference reactions. This is especially important in the treatment of seriously disturbed patients who become disruptive, and thus get labeled borderline, often as a response to unconscious countertransference manifestations from the analyst which are then experienced in the self-object transference as failures in empathy.(ABSTRACT TRUNCATED AT 400 WORDS)     

THE ANALYST'S WAY OF BEING: RECOGNIZING SEPARABLE SUBJECTIVITIES AND THE PENDULUM'S SWING

Whether the analyst finds the patient's emerging transference affectively tolerable or intolerable plays an important role in the analytic couple's negotiation of the configuration that the transference‐countertransference relationship ultimately assumes. If the analyst is deeply repelled by transference‐related roles to which he is assigned, patient‐ascribed attributions, or projection‐drenched interactions, he may react in violent protest, engaging in enactments that say more about his separable subjectivity than about the intersubjective situation. While there has been a recent trend to view enactments as a crucial aspect of psychoanalytic technique, this trend risks overlooking the way in which the analyst's way of being comes into play in the treatment.     

Psychic Truth and the In-Session Work of the Analyst

I seek to address one of the issues most affected by the postmodern culture, such as the crisis of rationality and truth, and try to reformulate its place within the psychoanalytic clinic using the contributions of Freud and Ferenczi, who drew the matrix of a passionate dialogue about the truth and the analyst work that has nurtured many contemporary theoretical developments. Essentially, the major influences of postmodern thought in psychoanalysis are to emphasize the importance of the patient–analyst interaction, the role played by the analyst in the patient’s transference and the rejection of the model of the analyst as a distant observer who interprets without having anything to do with whatever happens within the mind of the patient. Consequently, because both postmodernism and psychoanalysis are concerned with human subjectivity and love for truth, although indeed understanding them from different perspectives, both schools of thought become easily interrelated. I conclude that psychoanalysis, committed as it is with the search for truth, cannot ignore the influence of postmodern thought, as well as the postmodernist movement should not disregard all theoretical consistency provided by psychoanalytic theory and metapsychology.     

Fromm's Impact on Interpersonal Psychoanalysis: A Well Kept Secret

Erich Fromm was one of the founders of the William Alanson White Institute in New York City and an important contributor to the development of the interpersonal approach to psychoanalysis. Many of Fromm's ideas about psychoanalysis have found their way into the mainstream of analytic thinking. Much of what he taught in supervision and in his lectures had to do with the role of the analyst, the analyst's use of himself in the analytic process and the necessity that the analyst experience what his patient is experiencing. From did not necessarily use terms like projective identification but his understanding presaged much of what analysts talk about today. Fromm himself did not write much about clinical practice. And while he repeatedly expressed his respect for Freud he was explicit in his disagreements. Fromm rejected the notion of the analyst as a blank mirror. Instead, analysis requires a passionate wish for truth both in the analysand and the analyst. Fromm calls this passion biophilic, implying that the unconscious does not only harbor destructive drives that need to be tamed; it also harbors creative drives which, while also irrational, are constructive and need be liberated through the analysis.     

Analytic neutrality, anonymity, abstinence, and elective self-disclosure

Recent contributions to the psychoanalytic literature propose new ways of understanding analytic neutrality, anonymity, abstinence, and self-disclosure. They advocate elective self-disclosure by the analyst as an antidote to the allegedly game-playing quality of transference and resistance analysis. The analytic relationship, they assert, becomes unreal when attempts are made to observe the principles of neutrality and abstinence. Both are seen as ill-conceived because of the irreducible subjectivity and unwarranted authority of the analyst. These relational and interactional views are criticized because (1) they ignore the fact that transference and resistance analysis have from Freud onward been accepted as minimal criteria qualifying a clinical process as psychoanalytic; (2) elective self-disclosure carries metapsychological implications dismissing not only Freud's theory of motivation but motivation as a basic feature of human personality; (3) they do not recognize interpersonal relations as mental events and so do not consider the ego's ability to create intrapsychic representations of object relations; (4) elective self-disclosures within the empathic parameters of the analytic situation are themselves unreal compared to the reality of the patient's experience with other objects. Abstinence and neutrality as ideals facilitate maintenance of an internal holding environment or container for the analyst's countertransference.     

THE MYTH AND HISTORY OF SOME PSYCHOANALYTIC CONCEPTS: THOUGHTS INSPIRED BY A READING OF ORANGE ET AL., WORKING INTERSUBJECTIVELY

In this paper the author gives her reactions to a book on the intersubjective approach that deals with major issues such as the analyst's role in the psychoanalytic process, neutrality, technique and self-disclosure. Noting that the book often adopts an antagonistic and innovative stance towards Freud, she draws attention to aspects of his theories that deal with concepts deemed by the intersubjective school to be of fundamental importance. Chief among these is the influence of the analyst on the analytic process, in terms both of his 'defects' and of his individuality in general. In opposition to the 'myth of the isolated mind' attributed by the book to Freud, the author presents some selected passages from his works that emphasise the structuring function of the object and the influence of various groups on the individual. The aim of the paper is not only to counter the oversimplified view of Freud that emerges from the book but also to put forward a theoretical position with respect to a school that is exerting an increasingly powerful attraction on both sides of the Atlantic. The author's argument is based mainly on a discussion of the detailed clinical sequences featuring in the book. She also considers some possible cultural and social determinants of the development of the intersubjective trend.     

The transferential chimera II: some theoretical considerations

The author develops here a theoretical model to account for the different levels of organization and functioning of the transference chimera of which he gave a clinical presentation in an earlier article. From his reading of Jung's 'Psychology of the transference' he derives a dynamic model of the chimera and links it to quantum mechanics and chaos theory not so much to describe the reality of the phenomenon, but to offer a model of representation as a conceptual and meditative tool for analysts to use in their practice. The main hypothesis of this work is that the chimera arises from the intimate interplay of the respective de-integrates of the analyst and of the patient, thus constituting a genuine self in the transference. The author concludes with some implications for the analyst's own internal position.