Confidentiality and paradox: the location of ethical space

Implicit in Jung's alchemical metaphor of the vas bene clausum is the idea of an analytic frame with a space inside it for something vital, a relationship between two selves, to develop. For this to happen, analysts must respect their patients' rights to confidentiality. The paper explores the analyst's state of mind and the intrapsychic processes that are constellated when struggling with ethical dilemmas about issues of confidentiality in analytic work. The author suggests that at times when analysts consider breaking confidentiality, there is often a disturbing inner conflict between their moral principles (codes of ethics) and their internal personal ethical attitude. At these difficult moments, the mutuality of the work and the vas bene clausum can be significantly disrupted. The analyst tries to find a third position, a mental and emotional ethical space where the subjective and the objective, the ethical and the unethical can become more companionable bedfellows.     

PSYKOANALYTISKT ORIENTERAD PSYKOTERAPI

The increasing discourse of the concept of intersubjectivity in modern psychoanalysis has pushed the interest in the intrapsychic and its emphasis on drive and object into the background. Authors who wish to avoid a one-sided focus on intersubjectivity usually subscribe to a dual dimensional approach, taking both perspectives into account. In this article, the analytic situation is described not in two, but in three dimensions, the analytic function constituting a third dimension necessary for the interplay between the other two dimensions. Focusing on the analyst's position, the author presents a model that consists of (1) the-analyst-as-subject, (2) the-analyst-as-function, and (3) the-analyst-as-object. The analytic function is understood to be invested with a particular form of desire and it is argued that the asymmetry between this desire of the analyst and the desire of the analysand is a central characteristic of the analytic situation.     

Working in the Metaphor Commentary on Paper by Stephen Seligman

This paper expands on Seligman's ideas about mentalization and the challenges of working with patients who cannot mentalize. Seligman's clinical presentation demonstrates that much valuable analytic work takes place without explicit reference to the transference. Drawing on Britton's notion of the triangular internal space that allows for reflective thought, we propose that analytic interest in an external object, discovered through the relationship and meaningful to both patient and analyst, helps create the same kind of space. The difference-within-sameness of shared contemplation can increase receptivity to divergent perspectives. Likewise, the “third object” can become a therapeutic metaphor, open to various meanings without being limited to any one interpretation. We trace how Seligman and his patient use a series of third objects in their work together. In this process, the patient moves from a transitional relationship of minimal differentiation to an increasingly secure sense of her own separateness, beginning to accept, and even enjoy, having a motivated mind of her own. Finally, we discuss how Ferro's concept of the analytic field offers a theoretical rationale for the effectiveness of this process.     

Fixed‐links models for investigating experimental effects combined with processing strategies in repeated measures designs: A cognitive task as example

Fixed‐links models enable the investigation of experimental effects in combination with processing strategies in the framework of repeated measures designs. The consideration of different processing strategies is reasonable whenever the task requirements can be met in different ways. Effects due to specific processing strategies become obvious in comparing the models representing these processing strategies and also by investigating the variances of the corresponding latent variables. The usefulness of such models is demonstrated by the reaction time data of a cognitive task including three treatment levels. Two different processing strategies were considered: analytic and holistic. The results indicated that the participants applied both processing strategies. The analytic strategy was primarily applied for performing with respect to the second and third treatment levels and the holistic strategy with respect to the first treatment level.     

Confi dentiality with respect to third parties: A psychoanalytic view

It is assumed that confi dentiality is not one singular ethical entity but a conglomerate of quite different issues depending upon clinical context and the sector of information sharing at stake. The focus here is on how to think psychoanalytically about requests for information from third parties (payers, courts, public security). Defi ning confi dentiality as a promise to 'never tell anything' outside of the relationship omits evaluation of the impact of the third's listening on the combined freedom of thought and freedom of speech in analyst and analysand. Circulation of information outside the dyad need not be toxic, need not disrupt the analytic couple's openness to new meaning. Key to contamination and inhibition of analytic work is whether or not disclosure serves an analytic end. Current defense of confi dentiality relies heavily on the models of protection of privacy and professional secrecy, which, though useful and relevant, fail to encompass the transitional, intersubjective space engendered by the analytic process. Suggestions are made for alternate sources of paradigms better suited to represent the latter. Offered for discussion is a draft of a confi dentiality policy with respect to third parties that is informed by psychoanalytic theory and clinical practice rather than by local legal jurisdiction or original disciplines ethics codes.     

The analytic third: implications for psychoanalytic theory and technique

The author views the analytic enterprise as centrally involving an effort on the part of the analyst to track the dialectical movement of individual subjectivity (of analyst and analysand) and intersubjectivity (the jointly created unconscious life of the analytic pair--the analytic third). In Part I of this paper, the author discusses clinical material in which he relies heavily on his reverie experiences to recognize and verbally symbolize what is occurring in the analytic relationship at an unconscious level. In Part II, the author conceives of projective identification as a form of the analytic third in which the individual subjectivities of analyst and analysand are subjugated to a co-created third subject of analysis. Successful analytic work involves a superseding of the subjugating third by means of mutual recognition of analyst and analysand as separate subjects and a reap-propriation of their (transformed) individual subjectivities.     

Authority as paradox: The transformations of Don Quijote

The author's contention is that the analysand's temporary attribution of authority to the analyst is inherent in the analytic situation; this is seen as a transitional and paradoxical form of authority pertaining neither to internal nor external reality, but dwelling in the analytic third. The author proposes a conceptualization of psychoanalytic authority as a form of aesthetic authority according to Gadamer's defi nitions. While the scientifi c and hermeneutic codes for the understanding of authority in psychoanalysis assume that the main issue at stake is the delimitation of the objectivity or the subjectivity of the analyst's knowledge, this aesthetic perspective centres on the analysand's attribution of a claim of truth to analytic interpretations, and on the experience of recognition. The experience of recognition of a possible truth is particular and context-bound, as well as self-transformational. A reading of three episodes from Cervantes's The history of Don Quixote de la Mancha illuminates the transitional and paradoxical character of aesthetic authority within a transformational dialogue. These episodes are read as dramatizations of different positions vis-à-vis the paradoxical authority that characterizes transformational dialogues.     

Recognizing the component tones of a major chord.

Listeners judged whether a target tone was contained within a previously or subsequently presented major chord, and targets consisted of either the root, third, fifth, or tritone of the scale based on the root of the chords. Chord position influenced the relative recognition of targets, but listeners exhibited greater recognition of the fifth regardless of chord position (root, first inversion, second inversion). The data were not consistent with notions of root tracking or melody tracking. The data were broadly consistent with the notion that different chord positions may be harmonically equivalent (i.e., that listeners may recognize components of a chord regardless of chord position), with notions of analytic set and the importance of an instantiation of musical context for chord processing, and with the importance of the fifth in harmonic progression.     

Surviving Deadness in the Analytic Experience

The transference/countertransference (third space) analysis is considered to be central in the therapeutic effectiveness of the analytic process. Less emphasis has been placed on the actual experiences of analyst and analysand in the conflictual reenactment of third space experience and its resolution. This paper recounts the shared experience of a patient who was silent throughout most of the analysis, and my reaction, in fantasy and enactment, to this disturbing experience—both for him and for myself. I argue that it is the affective re-experiencing of past repressed trauma in the analytic space that has a therapeutic impact, leading to growth in the patient and also the therapist. I contrast Freud’s emphasis on insight, making the unconscious conscious, with Ferenczi’s suggestion that the therapeutic impact lies in the repetition of past traumatic experience in the analysis but with the possibility of a different outcome with a more benign object, leading to symbolic representation of repressed trauma. Re-experiencing and symbolization, in the third space, of past traumatic experience can be an exit point from the endless repetition of trauma in internal and external object relations, leading to a new beginning in the patient’s life. Immersed in the experience of deadness in the analysis, which had become a dead womb, the struggle to remain alive and thinking led to a rupture out of the dead womb, like the Caesura of birth, into aliveness and the ability to mentalize what had previously remained unmentalized.     

Working in the borderland: early relational trauma and Fordham's analysis of ‘K’

This paper outlines a view of early relational trauma as underlying borderline states of mind, and argues that Knox's 1999 paper on internal working models and the complex provides a basis for understanding such states of mind. The author argues that in addition to internal working models, the complex also embodies and contains primitive defences of the core self. He outlines how these apply on the objective, subjective, transference and archetypal levels, and in direct and reversed forms and applies this to the account of Fordham's analysis of his patient ‘K’, which ended in impasse. The paper explores the dynamic that emerged in that analysis and suggests that it could be helpfully accounted for in terms of the co‐construction and re‐construction of early relational trauma in the analytic relationship.     

Raiding the inarticulate: The internal analytic setting and listening beyond countertransference

The analytic setting exists not only externally but also internally as a structure in the mind of the analyst. The internal analytic setting constitutes an area of the analyst's mind where reality is defined by unconscious symbolic meaning. Clinical examples illustrate how a secure internal setting allows flexibility in the external setting without sacrifice of its analytic quality. The internal setting can help analysts listen inwardly to themselves in a way that is free-floating with regard to their internal processes. This points beyond usual ideas of countertransference. An analytic encounter may stir up elements that belong to the analyst's psyche which, rather than impeding the analysis, can actively enrich it. Seamus Heaney's writings evoke comparisons between listening to poems and listening to patients, and a week in a patient's analysis is described in relation to these themes.     

Mutuality*

Ferenczi’s striving for mutuality, a call which Freud didn’t take up, let him explore this concept with his analysands. He thus became the originator of mutual analysis, although with caveats, and of the concept of introjection, another important Ferenczian notion. The analyst’s attitude of knowing the ‘objective’ and independent Truth is changing its orientation into that of a co-construction in the analytic work; here the analyst and the analysand build a third internal world, which they share and which remains their own. Clinical vignettes illustrate the implications of these views.     

Visual parsing and priority effects in temporal order judgements of line drawn patterns

Five experiments are reported in which the perception of the order of the components of line drawn patterns presented in rapid temporal sequence on a visual display unit was investigated. In experiments 1 and 2, respectively, a schematic face and an asymmetrical geometric design, and a realistic face and a symmetrical geometric design were each divided into four fragments consisting of outline and three internal features. These fragments were presented to observers in sequences in which the position of the outline in the sequence was systematically varied. Observers reported the perceived order of the fragments. If the order was misperceived the interfragment interval was increased until the sequence was correctly perceived. Analysis of the pattern of perceptual errors and the interfragment presentation interval at which the sequence was correctly perceived indicated that observers tended to perceive the sequence correctly when the outline was presented in first or last position, but had difficulty in doing this when it occupied an intermediate position. This effect was significantly stronger with facial than with geometric patterns. Furthermore, in the case of two face patterns, errors were of a form where observers reported the outline presented in positions two or three as occupying positions one or four respectively. In experiment 3 an identical procedure was used to compare the perception of temporally fragmented normal and inverted faces. The outline position effect was equally strong in both cases. In experiment 4 the relative strength of the tendency to move the outline towards first or final position was assessed by dividing each of two patterns, a face and a house, into three fragments consisting of outline and two groups of internal features. Order perception was significantly better with outline in first or third position, but where it was presented in the intermediate position it was reported as being presented in first position. In experiment 5 the general pattern of results obtained in experiments 1, 2, and 3 was verified with the use of a methodology in which pattern fragment sequences and interfragment intervals were both randomised from trial to trial and the observer's task was to specify the position of the outline in the sequence. Four patterns--a normal face, a face with inverted internal features (INF face), a face outline with irrelevant internal features (IRF face), and a geometric design--were each divided into four fragments consisting of outline and three internal features.(ABSTRACT TRUNCATED AT 400 WORDS)     

Interpersonal conflict in group therapy: An object relations perspective

The aim of this paper is to demonstrate how object relations theory can be used to understand and regulate interpersonal conflict in group psychotherapy. Such concepts as projective identification, intersubjectivity and the analytic third are used to describe how conflict emerges in group psychotherapy and how it can be worked through. Case material is also provided to illustrate concepts and techniques in promoting a group's transition from a paranoid/schizoid to a depressive position. Positive aspects of the concept of projective identification are discussed including its use as a form of communication, a method of reducing anxiety and reintegrating previously dangerous and threatening aspects of the self.The paper was funded by Evan F. Lilly Memorial Trust Grant PV 13,067.     

Becoming and Being an Analyst in the British Psychoanalytical Society

The articles of Elizabeth Spillius and Jennifer Johns exemplify contrasting ways in which an analyst may form her psychoanalytic identity. She may recognize and accept a particular theoretical standpoint as valid, and form an analytic identity around that position. Or she may engage with a variety of viewpoints, and form an analytic identity through the interaction between these and her own internal self-experience. These approaches coexist in the British Psychoanalytical Society. There has been the potential for creative discussion between them, especially as regards their implications for analytic training. These six articles together, however, reveal how hard it has been for such discussion to take place. Spillius describes the disparity between the Society's three groups in relation to candidates' choice of supervisors, and I discuss this further. It seems to reflect an underlying difference in approach to psychoanalytic training, based on these different views of how an analyst's identity is formed. I suggest that the difficulty in debating this freely reflects a fear that opening up the issue might lead the Society to split. In 2005 the so-called Gentlemen's Agreement, which for 60 years governed group balance in the British Society, was formally abolished. In the light of this, I consider what is needed for a Society creatively to contain divergent philosophies of training.     

What analytic metaphysics can do for scientific metaphysics

The apparent chasm between two camps in metaphysics, analytic metaphysics and scientific metaphysics, is well recognized. I argue that the relationship between them is not necessarily a rivalry; a division of labour that resembles the relationship between pure mathematics and science is possible. As a case study, I look into the metaphysical underdetermination argument for ontic structural realism, a well-known position in scientific metaphysics, together with an argument for the position in analytic metaphysics known as ontological nihilism. I argue that we can ascribe the same schema to both arguments, which indicates that analytic metaphysics can offer an abstract model that scientific metaphysics may find useful.     

Assessing worry in older adults: confirmatory factor analysis of the Penn State Worry Questionnaire and psychometric properties of an abbreviated model

The assessment of worry among older adults typically has involved measures designed with younger cohorts. Because of special concerns in assessing older adults, modifications to existing instruments may be necessary. Addressing equivocal factor analytic data on the Penn State Worry Questionnaire (PSWQ) among younger adults, the authors conducted confirmatory factor analyses to evaluate the generalizability of previous models to older adults with generalized anxiety disorder. Data fit poorly with established single- and two-factor models. The single-factor model was modified, resulting in the elimination of 8 items, strong fit indices, high internal consistency, adequate test-retest reliability, and good convergent and divergent validity. Further psychometric work is required to assess whether the revised model is a more parsimonious method to assess late-life anxiety.     

Do medical decision analyses' largest gains grow from the smallest trees?

Some decision analysts recommend reserving their models for careful, complete study of complex problems. Others believe simple problem analyses provide the greatest gains. To clarify these issues, I tested: (1) whether simple published analyses compared to complex ones, produced results as non-intuitive; and (2) whether non-intuitiveness represented analytic gain (or equivalently, intuitive loss). Very limited data also examined (3) the gain from adding model intricacy for a given problem vs. selecting more complex problems for analysis. To assess two non-intuitiveness measures, 75 subjects (33 physicians and 42) non-physicians stated their intuitive preferences in 40 (22 published and 18 unpublished) medical dilemmas. For both physicians and non-physicians, simpler models (those with lees than 30 terminal branches in the decision tree) had about one third the non-intuitiveness of more complex ones. Three tests also supported the premise that analyses outperform intuition, therefore that on average the formers' non-intuitiveness reflects less analytic gain. In addition, for different models of the same problem, tree complexity did not correlate with gain. Thus, simpler trees may not generally gain less because they inadequately describe problems. Instead, simpler analyses may represent simpler problems, with more similar intuitive and formal solutions. If so, these findings may help us avoid some costly but unnecessary simple analyses.     

Recognition of Difference in the Author–Discussant Relation: Reply to Commentary

This author describes how poetry infuses her way of thinking, feeling, and writing and her way of working analytically. She introduces the concept of a nonanalytic third—the analyst's personal, intimate, and substantially abiding relationship to some body of experience unrelated to materia psychoanalytica. She posits that this nonanalytic third, the nature of which is unique to each analyst, constitutes a source of enrichment, texture, and dimensionality as well as personally compelling metaphors that the analyst may offer to the patient as other-than-me substance and a placeholder for cultivating the potential in the discourse of analytic potential space, in addition to serving as a facilitator and comfort for transition when the analyst must recognize and promote the necessary ending of an intimate analytic relationship.

Using Stephen Mitchell's notions of intersubjectivity and also using the analyst's and patient's separate role responsibilities in the creation of a context for the absence of conscious intentions, the author develops her concept of the nonanalytic third and the particular contribution of poetry to clinical process. These ideas are illustrated with a detailed case example of an unfolding analytic process that includes an e-mail exchange at the time when a shocking form of nonanalytic third appeared—September 11, 2001.     

Vector coding in slow goal-directed arm movements

It has been found that the estimate of relative target direction is consistently biased. Relative target direction refers to the direction in which a target is located relative to another location in space (e.g., a starting position in the case of goal-directed movements). In this study, we have tested two models that could underlie this biased estimate. The first proposed model is based on a distorted internal representation of locations (i.e., we perceive a target at the “wrong” location). We call this thedistorted location model. The second model is based on the idea that the derivation of target direction from spatial information about starting and target position is biased. We call this thebiased direction model. These two models lead to different predictions of the deviations that occur when the distance between the starting position and the target position is increased. Since we know from previous studies that the initial direction of slow arm movements reflects the target direction estimate, we tested the two models by analyzing the initial direction of slow arm movements. The results show that the biased direction model can account for the biases we find in the target direction estimate for various target distances, whereas the distorted location model cannot. In two additional experiments, we explored this model further. The results show that the biases depend only on the orientation of the line through starting position and target position relative to the plane through longitudinal head or body axis and starting position. We conclude that the initial part of (slow) goal-directed arm movements is planned on the basis of a (biased) target direction estimate and not on the basis of a wrong internal representation of target location. This supports the hypothesis that we code displacements of our limbs in space as a vector.