Transitional phenomena, projective identification, and the essential ambiguity of the psychoanalytic situation

Ambiguity, which is an intrinsic and essential aspect of the psychoanalytic situation, is related to the concepts of transitional phenomena and projective identification. The analyst's feelings of uncertainty that accompany this ambiguity are contrasted with a "pathological certainty." The consequences of the loss of ambiguity and the role of the analyst's countertransference in this process are described.     

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.     

Hearing voices: the fate of the analyst's identifications.

Using detailed clinical examples, the author illustrates the function of conscious and unconscious identifications with former training analysts, supervisors, teachers, and theorists in the mind of the working analyst. As compromise formations, analytic identifications are the product of loving and aggressive wishes, defenses against those wishes, and self-punitive trends that accompany the analyst in the work. The analyst's stance at any given moment has an identificatory history that may become conscious at certain times with certain patients. While the analyst's identifications modify over time, following a predictable developmental path, they are never fully given up, but consciously and unconsciously remain an active part of the analyst's inner life. During the clinical hour they are responsive to both the analyst's and the patient's conflicts, and they coexist in a dynamic reciprocal relationship with the patient's inner life.     

Future and potentiality in the psychoanalytic process

A perspective is delineated on the dimension of the future in the psychoanalytic situation. Clinical manifestations are presented of the tension between actuality and potentiality that characterizes the treatment situation. This tension, an aspect of the intersubjective field that exists between patient and analyst, involves the analyst's hopes, expectations, anticipations, sense of purpose, and therapeutic intent, facets of the analyst's subjectivity that affect the clinical process. The question of the patient's individuality and autonomy is raised in the context of the notion of the "true self." To understand potentiality in the clinical situation, it is argued, the intersubjective emphasis on the inevitable mutual influence between analyst and patient must be complemented by a view of the self as emerging from within and gaining coherence through the unfolding of inherent dispositions and potentialities.     

Subjective Well-Being in Adolescence: The Role of Self-Control,Social Support,Age, Gender,and Familial Crisis

Focusing on adolescents’ subjective well-being, the present study comprised three parts. The first examined the role of two coping mechanisms, self-control and social support, in predicting subjective well-being. The second related to the role of age and gender in predicting adolescents’ subjective well-being. The third raised the question of whether exposure to familial crisis would predict adolescents’ subjective well-being and whether self-control and social support would moderate the link between crisis and adolescents’ subjective well-being. Participants included 380 adolescents ages 13–17 years (M = 15.32, SD = .98; 194 boys, 176 girls, 10 unspecified), from six integrative junior-high and high schools in central Israel. All schools served a heterogeneous Jewish student population. Based on responses to a questionnaire identifying adolescents who reported experiencing a severe life crisis during the last year (e.g., severe illness in family, parent death or separation/divorce), the sample was divided into two groups: exposure to familial crisis (n = 96) and no exposure to familial crisis (n = 284). Outcomes revealed that both self-control and social support predicted adolescents’ subjective well-being. As expected, older adolescents presented lower levels of subjective well-being than younger ones. In contrast to the hypothesis, gender did not predict subjective well-being. Although exposure to crisis did not predict higher negative affect or lower positive affect, an interaction emerged between self-control and crisis in predicting positive affect. Thus, among adolescents who experienced crisis, better self-control skills predicted higher levels of positive affect.     

Slips of the analyst.

Understanding the analyst's work and its vicissitudes has been a major focus of recent psychoanalytic writing. This study on slips of the analyst represents an attempt to advance our understanding of analytic work. The slips described support the view that slips reflect not simply contributions from instinctual life, but active work-related goals of the analyst in carrying out the analytic tasks. Countertransference is discussed as reflected in the disturbance of intentionality betrayed by the occurrence of a slip. The essential role of the analyst's understanding his or her own reactions is emphasized.     

THE CONCEPT OF OBJECTIVE COUNTERTRANSFERENCE AND ITS ROLE IN A TWO-PERSON PSYCHOLOGY

Objective countertransference comprises those feelings the analyst experiences with the patient that are repetitions of feelings from the patient's life outside the analysis. It is viewed as being induced by the patient and is understood in the context of the patient's life, not the analyst's. The concept is used to understand the relationship of some of the analyst's feelings to recurrent interpersonal patterns in the patient's life. It has often been viewed as being incompatible with a two-person psychology. Here, in contrast, it is argued that objective countertransference is only one current within the analyst's total emotional response to the patient, and that it should be conceptualized as a component of a broader two-person psychology. However, the use of objective countertransference as a conceptual tool highlights aspects of the analytic relationship that differ from those emphasized in current two-person models. A case example is analyzed from both perspectives to illustrate their similarities and differences. Although the concept of objective countertransference can enrich the analyst's understanding of certain dimensions of the analytic relationship, it is not a theory of technique and it is not wedded to any particular style of psychoanalytic intervention.     

Call of the Wild

Freud described "wild analysis" as an undisciplined version of psychoanalysis; but the new Penguin series of Freud's writings collects many of his papers under the title Wild Analysis, challenging the differentiation. This paper traces wild elements at the core of psychoanalytic thought, crediting Groddeck, Ferenczi, and Winnicott for bringing them to the open. The image of the wild analyst can serve us as the image of the deeply involved, personally motivated analyst, whose work is intense and emotionally risky. This is the opposite of the "civilized" analyst who uses well-defined existing paths, takes no personal risks, and therefore stays at an emotional distance from his/her patients. Every analyst's capacity to develop a unique analytic self, based on his/her genuine life experience and worldview, is endangered if stepping out of line is slandered as "wild analysis" or as insanity. The relevance of these issues for contemporary psychoanalytic thought and education is demonstrated.     

The role of the analyst in the analytic cure during times of chronic crises

The role of the analyst in psychoanalytic treatment during periods of chronic crises is illustrated with material from two case studies. The first clinical vignette shows an analyst able to stay with fears evoked in the patient by the traumatic external reality, even as the analyst tried to explore with the patient an inner universe that handled this reality in unique ways. The second case study focuses on how the analyst's countertransference during this period of chronic crises, which she was experiencing along with the patient, made it difficult for her to contain the patient's fears and anxieties, because of the threat to her own existence, as well as to her identity as an analyst. In this second case the analyst, out of denial of the external situation, focused blindly on the patient's internal reality in order to counteract her own sense of passivity and helplessness in the confrontation with death and destruction. She clung to "classical" analysis by trying to analyze the patient's defenses, work them through, etc., thus making so-called analytic interpretations rather than staying with the patient's fear, as well as her own, and helping the patient more directly. A turning point came with the birth of the analyst's granddaughter; fear for the new arrival's safety made the analyst sharply aware that it is impossible to ignore external reality, that it must be given a place both in everyday life and in analysis. This awareness enabled the analyst to contain the patients' fears, which helped him feel more supported and facilitated change.     

On the psychoanalytic treatment of a psychotic breakdown

The author discusses the four-session-a-week psychoanalysis of a patient in psychotic breakdown with outbursts of violence. The analyst's first appearance in the transference was as a "rattle" (the noise made by his shifting in his chair), which constituted undeniable evidence of corporality--first the analyst's and then the patient's--leading eventually to the awareness of there being two separate persons in the psychoanalytic relationship. This case highlights the analyst's need to function in a particular way, and to allow him- or herself to be used in a particular way, in working with very disturbed patients, where issues of the body-mind relationship and of separation from the other are often central to the analytic work.     

Countertransference, conflictual listening, and the analytic object relationship

Analytic listening is an ongoing conflictual process, containing all the components of conflict and shaped in every moment by both the patient's and the analyst's conflicts. The mutual responsiveness that develops between analyst and patient stems from a complex conflictual object relationship, fundamentally no different from any other object relationship, in which countertransference at all times simultaneously facilitates and interferes with the analytic work. Detailed clinical process is used to illustrate these and related phenomena, including the use of signal conflict, the benign negative countertransference, the function of countertransference structures, and the analyst's use of projection. The analyst's affects, thoughts, and actions trace the shifting nature of the patient's transference and resistance, and the level of the object relationship continuously being created between patient and analyst.     

Is there a special psychoanalytic love?

Although the analyst's role mandates a degree of detachment, analysts have often said that they offer patients a special kind of love. They have tended to equate that love with understanding, thus neutralizing the paradox but also diluting the love. When something more resembling a loving affect is sought, the suggestions include the love a scholar feels for his subject, the love that accompanies immersion in great literature, and love that is self-generated by deliberate efforts to move toward the patient or to generate empathy in oneself. But a form of love may also arise from the analyst's unique and relatively pure acquaintance with a person's "appeal," by which is meant the patient's effort to elicit responses from the analyst. Although the awareness of transference most obviously tends to immunize him, it also gives him a poignant "insider's" feel of the patient's appeal, since he is the target of that appeal while being unencumbered by the myriad considerations that would color his perception were he to regard himself as a proper object.     

Life-threatening illness in the analyst

The literature on practicing throughout a life-threatening illness is reviewed and important differences about attitudes toward self-disclosure are understood by noting a division between two perspectives on transference: "one-body" and "two-body" views. The analyst's use of self-disclosure is informed by the prominence given the interpretation of transference as against that given the patient's needs in the collaborative relatedness supporting the therapeutic alliance. Themes and illustrative clinical vignettes are presented from the author's own experience practicing during such an illness. Three phases of working during illness are delineated, each somewhat different regarding the analyst's state, and hence patients' needs and reactions. Recommendations are made regarding conditions that make it possible to work effectively during a life-threatening illness. The analyst needs help from his or her own analyst to make the clinically and sometimes ethically appropriate decisions about practice; while this is important in instances in which the analyst recovers, it is essential should the analyst become terminal and face more certain death.     

Privacy, reverie, and the analyst's ethical imagination

The author illustrates varying ways of using and thinking about forms of analytic reverie and the analyst's privacy. He discusses a few different registers from which the analyst can illuminate points of transference-countertransference enactment. The modality by which the analyst communicates these formulations of unconsciously held object relations and defenses varies and includes verbal interpretation through symbolic speech, interpretive action (Ogden 1994a), and, at times, interpretations that involve a construction of the analyst's subjectivity put forward to enhance the patient's understanding of enactments of the transference-countertransference. The author develops a concept, the analyst's ethical imagination, defined as the ways in which we consider and anticipate the implications of our interpretations.     

Creating analysts, creating analytic patients

This paper applies a contemporary, 'two-track'- transformational as well as archaeological - perspective on psychoanalytic process to clinical issues in the creation of analytic patients: case finding, recommending analysis, and recommending and negotiating the intensification of frequency of sessions in analytic psychotherapy. Central importance is assigned to the role of the mind and analytic identity of the analyst, including the analyst's capacity to maintain an internal analytic frame and analyzing attitude from the very first contact with the patient and throughout the treatment, the analyst's confidence in and conviction about the usefulness of analysis for a given analytic dyad and the role of the analyst's theory, which must be broad and consistent enough to allow the analyst to feel that he or she is operating analytically when addressing non-neurotic (unrepresented and weakly represented mental states) as well as neurotic structures.     

“Why do (don't) you ask?” transference and the desire (not) to know

One of the criterial distinctions of psychoanalysis is its renunciation of indoctrination through suggestion. In spite of the fact that psychoanalysis is both an organized body of knowledge and a disciplined form of interpersonal influence, it regards an analyst who tells the analysand what to think or do as essentially doing harm by substituting a new form of prejudice and alienation for the preexisting form he is attacking. Even though an analyst regards his knowledge of psychoanalytic theory as adequate at a general level, this "truth" is not an adequate mode of discourse with an individual. Why not? It is a fact that analysands often do not accept an analyst's idea. However, the fundamental problematic of clinical psychoanalysis comes precisely at the point that the analysand would accept the analyst's idea, involving the distinction between a properly psychoanalytic cure and a transference cure. Psychoanalytic theory itself holds that unreflective incorporation of another's idea about oneself comes at the expense of autonomous and spontaneous self-revelation. Despite its resolute pursuit of new truths, the aim of psychoanalysis is less concerned with attaining specific ideas about unrecognized conflicts than it is with achieving a general attitude--that self-understanding requires a capacity to admit dubious and unwanted ideas and feelings that symptoms, dreams, and free associations bring to light. This "psychoanalytic" attitude permits a new type of discourse in which the person recognizes himself or herself through expression, rather than parrotting the analyst's (or others') words, or continuing rigidly to hide the truth of desire for oneself. In the long run, psychoanalysis offers to correct a primary misunderstanding: that one can acquire a comprehensively true image of oneself. As Barratt (1988) emphasizes, this transformation is tantamount to a change in personal epistemology for the analysand and a change in epistemological theory for the culture as a whole. In our culture, most analysts and lay people alike take for granted that the ego is an agent that is to be integrated and strengthened in order to direct one's life. Likewise, the unconscious is commonly regarded as a type of savage alter ego that must be mastered by the ego. According to Lacan's critique, the ego is a snare and a delusion for the patient, however highly commended by society it may be, because its very essence is to furnish the illusion of enduring self-knowledge.(ABSTRACT TRUNCATED AT 400 WORDS)     

Free-swinging attention

Psychoanalytic listening enlists the analyst's capacity for, and relative comfort in, rapidly shifting levels of attention and organization. Such shifts are not effortless and can be characterized as part of "free-swinging attention," a term that suggests some dimensions of the analyst's work. The need to establish meaning in the individual and immediate context parallels the task of a child in learning language, and the role of the analyst as child is an important if usually overlooked one. The author compares psychoanalytic with psychotherapeutic listening, as well as some current views on free association and evenly suspended attention.