Catching the wrong leopard: courage and masochism in the psychoanalytic situation

This paper introduces the subject of courage into the psychoanalytic discourse about masochism and also demonstrates that ordinary ethical and axiological concerns can and should be included in our psychoanalytic language and practice. At each stage of a psychoanalysis, it may be helpful to consider whether the patient's experience might be that taking a step deeper into the psychoanalytic relationship is both courageous and masochistic. This consideration can open the door to exploration of conscious beliefs and how they are related to unconscious fantasies and assumptions. Considering the possibility that even a sadomasochistic enactment may simultaneously represent a courageous attempt to rework conflict or trauma can enrich the way analysts listen to both manifest and latent material.     

Implicit relational knowing: Its role in development and psychoanalytic treatment

It is increasingly apparent that “something more” than interpretation is needed to bring about change in psychoanalytic treatment. Drawing on clinical and developmental observations, we propose that interactional processes from birth onward give rise to a form of procedural knowledge regarding how to do things with intimate others, knowledge we call implicit relational knowing. This knowing is distinct from conscious verbalizable knowledge and from the dynamic unconscious. The implicit relational knowing of patient and therapist intersect to create an intersubjective field that includes reasonably accurate sensings of each person's ways of being with others, sensings we call the “real relationship.” This intersubjective field becomes more complex and articulated with repeated patient–therapist encounters, giving rise to emergent new possibilities for more coherent and adaptive forms of interaction. During a transactional event that we term a “moment of meeting,” a new dyadic possibility crystallizes when the two persons achieve the dual goals of complementary fitted actions and joint intersubjective recognition in a new form. We argue that such moments of meeting shift the relational anticipations of each partner and allow for new forms of agency and shared experience to be expressed and elaborated. © 1998 Michigan Association for Infant Mental Health     

The play of transference: some reflections on enactment in the psychoanalytic situation

The incessant play of nonverbal activity between patient and analyst actualizes and amplifies the primary verbal data of the psychoanalytic dialogue. Both parties must inevitably register this kinesic level of communication, and react with capacities acquired in and elaborated from earliest childhood. The analyst's apperceptive (unfocused) looking, as part of his freely hovering attentiveness, utilizes these capabilities gradually to perceive and organize patterns combining the verbal and nonverbal data. It is through the recognizing and eventual understanding of these gestalts that the analyst builds up his knowledge of his patients. In these patterns can be identified: (a) conspicuous behaviors, idiosyncratic for the individual, which often yield to psychoanalytic inquiry to reveal their dynamic-historical antecedents; and (b) inconspicuous background kinesics, habitual to the individual, which ordinarily are opaque to analytic exploration, yet hold rich meaning. Observing these small behaviors in relation to verbal content provides evidence of their linkage to, and enactment of, pregenital- and genital-level conflicts over diadic and triadic object relations, even in highly structured personalities. These enactments combine elements of play, miming, and drama to constitute an experiential dimension that actualizes and externalizes the patients' inner life of conflict and relation to objects.     

Beauty treatment: the aesthetics of the psychoanalytic process

Psychoanalysts enjoy doing analysis above and beyond its usefulness to patients; one reason for this lies in the aesthetic pleasure the analyst may derive from the analytic process. The author discusses this aesthetic pleasure from the standpoint of meaning making, communication, love, and professional craft. Patients may themselves seek in analysis a certain kind of beauty that is normally a byproduct of good enough empathy and communication. Using Kleinian theory, the author examines the ways in which destructiveness and aggression may be understood in relationship to an aesthetic of psychoanalysis. It is further proposed that the aesthetic and ethical principles of psychoanalysis are indissolubly linked.     

Introduction: The role of shame in psychoanalytic theory and practice

Introducing three papers by Leon Wurmser, Claude Janin and John Steiner the author gives an overview of the development of the concept of shame in psychoanalytic theory and practice. Different aspects of the phenomenon of shame are being discussed including its relation to guilt, object relations and identity as well as the role of gaze when emerging from a psychic retreat.     

The creative process in psychoanalytic treatment

Conclusion In summary, then, what is conducive to creative functioning is arelaxation of one's rationality: the analyst who feels exhilarated rather than threatened, receptive rather than anxious, at the hint of an appearance of the unexpected, at the peeking out of something that may challenge his understanding, that may not fit the theory neatly—he is the one who is capable of more creativity. The analyst might thus orient himself to give rein to his own inner processes, his inner radar rather than his intellect, and thus without preconceived theoretical expectations aspire to discover anew that which is uncovered ineach patient. It is this which makes each analysis a fresh experience, not a stale rehash, for the therapist; it is this which makes the analysis an authentic encounter for the patient—thus, an adventuring together.Another factor grows out of the above. If the analyst orients himself to think-feel-respondvia that deeper more personal channel of images — closer to the language of dream images early in the history of analysis recognized as the royal road to the unconscious—then he may find his creative responsiveness more liberated, his intuition in general more active for the work of the session. He thereby may enliven his reactivity not only along the pithy, affect-enriched modality of images, but also along other dimensions of intervention involving more nuanced responses of all sorts.Read at the convention of the Metropolitan Academy of Psychoanalytic Training, March 12, 1971, New York City, panel on The Creative Process.     

The effectiveness of psychoanalytic psychotherapy: the role of treatment duration, frequency of sessions, and the therapeutic relationship

This is an effectiveness study of treatment outcome that relies on patients' perception of their mental health during and after psychoanalytic psychotherapy. Ninety-nine outpatients attending the IPTAR Clinical Center (ICC) responded to the Effectiveness Questionnaire (EQ) adapted from that developed by Consumer Reports. Effectiveness is studied from various perspectives. Findings indicated (1) an incremental gain in effectiveness scores from six to over twenty-four months of therapy; (2) an incremental gain with greater session frequency from one to two or three weekly sessions; (3) facilitation of effectiveness by the experience of a positive relationship with the therapist; (4) an interplay between clinical syndrome and treatment conditions. A method giving clinical validity to the quantitative findings is described. Brief summaries of two recorded interviews reveal differential reconstruction of events that had occurred during treatment. The findings are discussed from the vantage point of two hypotheses: cognitive dissonance and internalization of therapeutic experience.     

Dream actors in the theatre of memory: Their role in the psychoanalytic process2

The author notes that neuropsychological research has discovered the existence of two long‐term memory systems, namely declarative or explicit memory, which is conscious and autobiographical, and non‐declarative or implicit memory, which is neither conscious nor verbalisable. It is suggested that pre‐verbal and pre‐symbolic experience in the child's primary relations is stored in implicit memory, where it constitutes an unconscious nucleus of the self which is not repressed and which influences the person's affective, emotional, cognitive and sexual life even as an adult. In the analytic relationship this unconscious part can emerge essentially through certain modes of communication (tone of voice, rhythm and prosody of the voice, and structure and tempo of speech), which could be called the ‘musical dimension’ of the transference, and through dream representations. Besides work on the transference, the critical component of the therapeutic action of psychoanalysis is stated to consist in work on dreams as pictographic and symbolic representations of implicit pre‐symbolic and pre‐verbal experiences. A case history is presented in which dream interpretation allowed some of a patient's early unconscious, non‐repressed experiences to be emotionally reconstructed and made thinkable even though they were not actually remembered.     

A core process in psychoanalytic treatment

A core mechanism of the psychoanalytic process is described. This involves the effects of treatment on an ongoing "unconscious intrapsychic process," which has specific points of vulnerability to pathology. The concept of an intrapsychic process described by the author in previous publications is an expanded formulation of the idea of thought as trial action and of the signal theory of anxiety. The psychoanalytic method alters the functioning of the ego astride this unconscious process, strengthening its control over anxiety, defense, trauma, and symptom formation. This is mutative in the psychoanalytic method.     

Working with shame in psychoanalytic treatment

Shame is a central human affect, reflecting feelings of defect, inferiority, and failure of the self. It is, therefore, a proper focus for psychoanalytic treatment. Beginning with Freud's seminal attention to narcissism and the ego ideal, the possibility for studying shame and its relation to the ego ideal (i.e. the loving function of the superego) was inherent in psychoanalytic theory, but Freud's pursuit of intrapsychic conflict and the punitive superego postponed further elaboration of shame. Interest in the relation of the ego ideal to the superego (Hartmann, 1950; Reich, 1954), and in the ideal self (Sandler et al., 1963; Schafer, 1960, 1967) opened the way to further study of shame. Kohut's contributions, with their focus on narcissism and self-pathology, have given a language and perspective on self-deficits allowing elaboration of shame's place in psychoanalytic treatment. In this paper, I have focused on the treatment of shame in two patients. I suggest that shame lies at the very center of the narcissistic patient's pathology, with primary internal shaming (directed at the self's failures and inadequacies) permeating all aspects of the treatment. For the neurotic patient, shame is more circumscribed, reflecting partial failures of the self; it tends to be reactive, relating to passive withdrawal from internal conflict and castration fears, and is intermixed with oedipal manifestations. I have described clinical sequences that demonstrate my approach to working with shame in each of these patients. In both cases, the task is to recognize, acknowledge, accept, and investigate the patient's shame. Only after such empathic investigation can underlying conflictual and genetic derivatives be productively pursued. This sequence is often intuitively followed in analysis, but in this paper I have attempted to articulate more systematically shame's role in psychoanalytic treatment.     

Model scenes: implications for psychoanalytic treatment.

Model scenes are constructed by analyst and patient to organize puzzling information, integrate previous understanding, and initiate further exploration of experience. They are derived from a variety of sources: literature (oedipal myth); transference; ordinary or traumatic childhood events that occupy a pivotal position. Model scenes may conceptualize experiences of any age and motivational system, and are contrasted with screen memories and "telescoping" of events. Two clinical examples are used to illustrate the relation between the model scene and the transference. Model scenes provide a valuable clinical tool for moving from general to specific experience. They afford empathic entry into the transference experience and the opportunity through which the experience of motivations representative of past and present can be conceptualized and integrated into a cohesive self organization.