A framework and two sketches concerning psychoanalytical training and practice

The author discusses the mode of knowledge production in psychoanalysis based on a reflection on the psychoanalytical education and its relationship to clinical practice. She points out that there is a risk in a form of clinical activity found in our education, which, under the fascination of the analyst's power of operating in the metaphorical domain of words, loses sight of the material dimension of the clinical action. In other words, this form of clinical activity loses sight of the meeting with another human being, of the repertoire of theories and experiences that informs this action and the patient's and the analyst's concrete life situation. The author highlights the role of writing as a privileged way of dealing with the material and immaterial facts that constitute the clinical action and reflects on some of the forces that structure nowadays the reception of knowledge production inside the psychoanalytical field. She uses the notion of 'minor literature', by Franz Kafka, to express the possibility that a live circuit of writings exchanged among psychoanalysts can offer to an interchange of experiences and ideas that is the live expression of the history of the psychoanalytical groups. A clinical session is presented in order to promote considerations about the psychoanalytical education, theory and practice.     

Fonagy and Freud. Psychological versus psychic reality

Peter Fonagy and Mary Target present their Playing with reality theory as a developmental theory centred on the concept of psychic reality. This paper compares Fonagy and Target's use of the concept of psychic reality with Freud's original concept. It is argued that the concept of psychic reality has been redefined from delineating a psychic reality stemming from the unconscious to denoting a kind of conscious or preconscious psychological reality characterized by an experience of equality between the internal and the external worlds. The theoretical discussion is illustrated by being applied to eating disorder pathology, which by Fonagy and colleagues is described as associated with thought processes characterized by psychic reality.     

Psychoanalytic process and thought: Convergence of Bion and Matte‐Blanco1

Using the convergence between Bion and Matte‐Blanco, in this article the author attempts to stress the view of the psychoanalytical method as promoter of expansion of the ability of the patient to think his emotional experiences. After a brief résumé of the ideas of both Bion and Matte‐Blanco, certain points of congruence between the two are emphasised: the way of perceiving the range of phenomena observed by psychoanalysis, intuition as a method for observing this field, the feelings as the raw material for thinking, and the importance of the concept of infinity in psychoanalysis. The way in which the ideas of Matte‐Blanco assist in the understanding of Bion's propositions is highlighted. Following these correlations, the author discusses certain questions pertinent to the psychoanalytical method and proposes a model in which the analyst acts as a mediator/catalyst in the process of revision of the ways in which the patient has organised his emotional experiences and the theories constructed to support these hypotheses. Samples of clinical material are presented.     

The illumination of history

Formulations regarding the patient's history have not only played an important part in understanding the patient, but interpretations explicitly linking the present with the past have been seen as central to the therapeutic process. In this paper the author considers the role of historical reconstruction in bringing about psychic change. He emphasizes the therapeutic value that lies in the exploration of the way the patient's history is embodied in his internal object relationships, becoming manifested in the transference-countertransference relationship. The author presents clinical material which he suggests allowed the analyst to follow the way the patient's internal object relations, coloured by her history, became expressed and played out in the sessions. He suggests that, when these processes can be followed and addressed in the present, this may lead to a diminution in the underlying anxieties. This can thus promote psychic change by freeing the patient's capacity to achieve a sense of connection with her history, and to tolerate the meaning of what emerges, which illuminates both the present and the past.     

A skin for the imaginal

This paper focuses on the development of internal space, the evolution of psychological boundaries and the capacity for symbolization as they first arise during infancy. The concept of the psychic skin as an early form of psychological boundary is presented. The development of the psychic skin, or psychological container, is necessary for imaginal processes to function for the purpose of psychological growth and development. Infant observation material utilizing the Tavistock model and analytical material from an adolescent analysis is presented to help elucidate the theoretical concepts.     

Metapsychology or metapsychologies? Some comments on Paul Denis's paper ‘The drive revisited: mastery and satisfaction’

In this commentary on Paul Denis's paper ‘The drive revisited: mastery and satisfaction’, the author defends the idea of a plurality of metapsychologies that must be contrasted with and distinguished from each other while avoiding incompatible translations between models. In this connection he presents various theoretical approaches to aggression and the death drive, and demonstrates the differences between the drive model and the model underlying the theory of internalized object relations. The author holds that the concept of the internal object differs from Freud's notion of the representation (Vorstellung). He also considers that the imago as defined by Paul Denis in fact corresponds to the concept of the internal object. Lastly, he addresses the complex issue of listening to archaic forms of psychic functioning and their non‐discursive presentation within the analytic process, which affects the transference‐countertransference link.     

The concept of psychical trauma: A bridge in interdisciplinary space1

The concept of trauma currently occupies a central position in interdisciplinary dialogue. Using the concept of psychical trauma as a bridge, the author attempts an interdisciplinary dialogue with psychiatry, biology and neuroscience. Beginning with the concept of psychical trauma in Freud, the author reviews the evolution of Freud's thinking, and links it with the ideas of Ferenczi and post‐Freudian psychoanalytical authors. From a different framework, he considers the present state of research on post‐traumatic stress disorder in current psychiatric nosography and attempts an interdisciplinary approximation to the concept of psychical trauma. Interesting ideas like the traumatic situation, trauma spectrum and psychopathological spectrum emerge, which enable a better understanding of the concept of psychical trauma through its relatedness, as a bridge connecting a broad psychopathological range extending from normality to psychosis. The ensuing possible relative loss of nosographical rigour is more than compensated by the resulting increased understanding and enlarged therapeutic possibilities. In the second part of the paper, the author attempts a dialogue with neuroscience, taking into account new advances in current research on emotion and memory, and making them compatible with the psychoanalytical concept of trauma. In this sense, the paper underlines the importance of emotion and crucially of memory, regarded as a fundamental axis of the subject explored in this paper. Here a substantial distinction which is pertinent for analytical work appears: declarative memories versus non‐declarative or procedural memories. In a concluding discussion the author argues that, taking into account the implications of these current notions regarding a number of theoretical and technical aspects, psychoanalysis currently holds a privileged position, both in its potential for prevention and regarding the treatment of patients, in so far as, through interdisciplinary dialogue, psychoanalysis can be receptive to and be enriched by the contributions of other disciplines, just as it enriches them with its own contributions.     

The psychodynamic of panic attacks: A useful integration of psychoanalysis and neuroscience1

This article tries to explain, in the light of some neuroscientific and psychoanalytical considerations, the repetitive pattern of panic attacks. Freud considered the panic attack as an ‘actual neurosis’ not involving any conflictual process. Recent neuroscientific findings indicate that psychosomatic reactions, set off by a danger situation, depend on the primitive circuit of fear (including the amygdala) characterised by its speed, but lack accurate responses and may also be activated by harmless stimuli perceived erroneously as dangerous. The traumatic terror is stored in implicit memory and may be set off by a conditioned stimulus linked to a previous danger situation. In the panic attack, the traumatic event is created by the imagination and this construction (a micro‐delusion), built in loneliness and anxiety, has the same power as the real trauma. A mutual psychosomatic short‐circuit between body and psyche, in which terror reinforces the somatic reactions and the psychic construction, is established. Therefore, it is important to highlight these constructions in order to analyse and transform them. In the second part of the article the author reviews the main psychoanalytical theories about panic attacks, stressing how, in his opinion, panic attack is a consequence of the breakdown of the defence organisation at various levels and may appear during periods of life crisis. Two patients suffering from a deficit of personal identity are presented. The various organisations and the different levels (biological, neuroscientific, associative, traumatic) of the panic attack determine different kinds of therapeutic approaches (pharmacological, cognitive and psychoanalytical). While the psychopharmacological treatment is aimed at reducing the neurovegetative reaction and the cognitive method is attempting to correct the associative and perceptive processes of fear signals, psychoanalytical therapy represents both a specific means to free patients from panic attacks as well as an indispensable route for their emotional growth.     

Zur Theorie und Praxis psychoanalytisch begründeter station?rer Psychotherapie

In the last 50 years inpatient psychosomatic psychotherapeutic treatment in Germany has undergone a special development in which the psychoanalytical and group analytical communities were substantially involved. This development will be analyzed in a review with respect to models of the clinical application of psychoanalytical treatment principles. Particular emphasis is placed on the analysis of transference and countertransference processes in a clinical multiperson situation and the resulting necessity of group and teamwork. Only such an integrative inpatient psychotherapy concept is from a psychoanalytical perspective in a position to utilize the interactional, scene-like restaging in a multiperson relationship field and to benefit therapeutically, by which the group analytical function of the team process plays a special role. The practical aspects of two applications of the integrative model in Essen and Dortmund will be presented and the results will be discussed.     

Christer Sjödin interviews Jan Stensson

Abstract

The author examines different definitions and applications of the terms “psychic energy” and “libido.” With regard to the “psychic energy” terminology, he shows that its application and usage relate in particular to the perspective of Brenner and not to Freud's definition. He argues that Freud uses the term “psychic energy” as a synonym for “libido,” and not “libido” as a synonym for “psychic energy.” It is demonstrated that in Freud's view, up until 1914, “libido” relates to manifestations of bodily sexual tensions, and subsequently this term applies to the manifestations of sexual energy in the psychic field. The author rejects this change in terminology and also challenges Freud's attempt to use dynamic-economic considerations as an explanatory device for epistemological reasons. Freud's concept of energy is inconsistent with the meaning of energy as defined in the physical sciences, and whereas the metapsychological topographical, dynamic, and structural viewpoints have a solid foundation in the representational world to which the psychoanalytic process affords unique access, this is not true of the economic viewpoint. It is claimed that bodily tensions only exist in the representational world in the form of affects, so that, in the author's opinion, the economic viewpoint should be abandoned in favour of an affective one. In the context of the endeavour to obtain pleasure and avoid unpleasure adduced by Freud, this viewpoint focuses on the relationships between affects and the different elements of the representational world, thereby serving as the subject of metapsychological investigation.     

From psychic holes to psychic representations

Abstract

In this essay, I will explore the term “psychic hole,” and compare it to similar terms from the world of astrophysics and terms used in the psychoanalytic literature. I will then present my own conception of the “psychic hole” in cases of Holocaust survivors' offspring. I will explain how this “hole” is created, and describe a particular aspect of the “psychic hole” that is unique to Holocaust survivors' offspring, namely the enactments (termed “concretization” by Bergman) generated by the negated traumatic themes that reside in it. I will illustrate these enactments using clinical material taken from case studies of Holocaust survivors' offspring that I have previously published. The clinical vignettes reveal the transgenerational impact of the memory hole resulting from negation of survivor parents on the lives of their offspring, up to the third generation. They also show the painful journey from enactments to psychic representations, a journey which exposes the traumatic events that have been denied or repressed, and facilitates the work of mourning and the eventual achievement of a better integrated self. Finally, I will offer technical suggestions for analysts to help patients transform psychic holes into psychic representations.     

Psychoanalyse und Traumatherapie

The author is of the opinion that for patients with combined traumas of commitment and violence a psychoanalytical long-term treatment which takes into consideration the peculiarities of this group of patients will continue to be the therapy of choice. Special ??trauma therapies?? may be useful after acute traumas and in cases in which external conditions exclude psychoanalytical treatment. Depending on the situation of the individual case, though, specific modifications of the technique may be necessary, which possibly include proven specific trauma therapeutic techniques as parameters. Based on the parallelism of the economic aspect of the trauma and the aspect of object relationship, a decisive role in the therapeutic process befits the recognition of the traumatic reality and the working out of traumatic transference, which, however, must not traumatize under any circumstances. This is accompanied by the restitution of a good interior object, which only becomes possible within a frame giving security and support. The establishment and preservation of this frame may also be due to especially required parameters derived from trauma therapies, the psychodynamic significance of which must be analyzed with the individual patient. The author's approach is clarified by two case vignettes in which the theoretical reflections have led to very different technical procedures. The author comes to the conclusion that the psychoanalytical trauma therapy shows how therapeutic concepts aiming at an optimum result must still be tailored to the individual case.     

Human time and dreaming

One characteristic of massive trauma is a persistent feeling that time is frozen, i.e., an experience impossible to integrate into a psychic reality. In this paper, the author sets out to explore the dimension of time in the psychoanalytical situation in an effort to shed light on this question. The infant acquires an immediate sense of time through the rhythm of frustration and satisfaction, and out of these encounters, a fundamental dialogue evolves. This primary dialogue is internalised and is regarded as an indispensable structure for psychic life. The child's existence is impregnated by unconscious desires or beliefs of the adult world—enigmatic messages that will constitute an unconscious source of the child's own psychic reality. Timeless desires and enigmatic messages urge on a dreaming in attempts to carry over the psychical sense of time and the implacable time of existence. When we infuse a time dimension through our dreaming and our narratives, we give shape to our timeless wishes. The psychoanalytic situation arouses the primary dialogue and an elementary experience of time. Traumatic experiences are tantamount to the absence of the primary object and thereby the death of time. Dreaming becomes an endeavour to create a psychic space, the aim of which is to restore the primary dialogue. If circumstances obliterate all hope of re-establishing the bond to the primary object, the sense of time is destroyed as well. The author concludes that the experience of time and elaboration of traumatic experiences are closely connected.     

Out of the body: embodiment and its vicissitudes

Body‐mind dualism and the consequent neglect of the body of the analyst can have important negative effects on the analytical process leading all too often to misinterpretations of the analysand's verbal and non‐verbal communications and to disturbances of analytical temporality. This is intensified when we are dealing with individuals where disembodiment and states of psychic deadness are central features. The paper explores the philosophical roots of the idea of a disembodied mind and the way in which this impacts our relationship with the world. While André Green's concept of the dead mother and disturbances in the sense of self‐agency have been held to play an important role in states of psychic deadness, I suggest that it is rather disturbances in the sense of body ownership and of the body image which are more central. The paper then discusses the particular kinds of countertransference that can be evoked in the analyst when we find ourselves dealing with this type of patient and suggests how we can use our embodied countertransference to become aware of and elaborate our own feelings of deadness in order to overcome the loss of temporality that is characteristic of such states. This is illustrated with reference to my work with a young man with a masochistic perversion and a severe disturbance of the body image with an accompanying profound sense of psychic deadness.     

Gef?hrliche N?he

The author examines the association between trauma and psychosis. To illustrate this he presents clinical examples of active and passive experiences of violence by adult psychotic patients, for whom forerunners in the form of childhood experiences of violence were found in some psychoanalytical treatments. They take place in traumatic relationships. Recent empirical studies have shown that trauma plays an influential role in the pathogenesis of schizophrenia. Traumatic relationships have a contradictory structure which possesses an impressive similarity to the schizophrenic dilemma of adult psychotics. The author therefore considers the schizophrenic dilemma as an introspective manifestation of a traumatic relationship, a part of the violent nature of psychiatric institutions as re-enactment of the traumatic relationship.     

The colourless canvas: representation, therapeutic action and the creation of mind

Freud's initial formulations viewed psychoanalysis as working towards the rediscovery of psychic elements - thoughts, feelings, memories, wishes, etc. - that were once known - represented in the mind, articulatable, thinkable - but then disguised and/or barred from consciousness. His subsequent revisions implicated a second, more extensive category of inchoate forces that either lost or never attained psychic representation and, although motivationally active, were not fixed in meaning, symbolically embodied, attached to associational chains, etc. Following Freud's theory of representation, the author conceptualizes these latter forces as "unrepresented" or "weakly represented" mental states that make a demand upon the mind for work and require transformation into something that is represented in the psyche, if they are to be thought about or used to think with. This paper describes, discusses and presents illustrations of this transformational process (figurability),that moves intersubjectively from unrepresented or weakly represented mental states to represented mental states, from force to meaning, from the inchoate to mental order.     

‘Am I a Ceadas child?’: exploring the nature and experience of shame in the psychotherapy of an adolescent boy

Although shame is a central affect running through all phases of psychosexual and social development, it is usually masked by guilt and therefore it is not readily recognised, explored, and understood within the therapeutic situation. Moreover, there is a tendency to treat all shame manifestations as if they operate at the same level. The author proposes the need to distinguish between two qualitatively discrete manifestations of shame states which, albeit intertwined, operate at different levels and require different understanding and technique: a primary, unconscious kind based on psychobiological survival and triggered by a condition of psychic and physical danger, and a secondary, social shame, mainly conscious, based heavily on vision and evoked in social situations. The natural, primary form of shame becomes pathological after catastrophic chronic exposure of the primitive ego to unthinkable anxieties. Such premature rupture of primary skin containment may result in omnipotence-based pathological organisations impeding or precluding acceptance of guilt and need for reparation. Pathological primary shame predisposes the individual to states of pathological secondary shame. When initial traumatic conditions are re-activated and re-experienced in therapy, they may trigger re-enactments and, possibly, a negative therapeutic reaction. Recognising variations and mixed states of primary and secondary shame states, especially when shame is compounded with guilt, can provide guidance in the assessment of the fragility of the ego, and therefore inform our technique and the therapeutic process. This theoretical position is discussed with the help of clinical material from a twice-weekly psychotherapy of a 16-year-old boy imbued with shame compounded with guilt, related to transgenerational objectification and dehumanising experiences.     

Thanatos and massive psychic trauma: the impact of the death instinct on knowing,remembering, and forgetting

The connection between massive psychic trauma and the concept of the death instinct is explored using the basic assumptions that the death instinct is unleashed through and is in a sense characteristic of traumatic experience, and that the concept of the death instinct is indispensable to the understanding and treatment of trauma. Characteristics of traumatic experience, such as dissolution of the empathic bond, failure to assimilate experience into psychic representation and structure, a tendency to repeat traumatic experience, and a resistance to remembering and knowing, are considered as trauma-induced death instinct derivatives. An initial focus is on the individual, on how death instinct manifestations can be discerned in the survivors of trauma. Next the intergenerational force of trauma is examined; a clinical vignette illustrates how the death instinct acts on and is passed on to the children of survivors. Finally, the cultural or societal aspects of trauma are considered, with an eye to how death instinct derivatives permeate cultural responses (or failures to respond) to trauma. Because trauma causes a profound destructuring and decathexis, it is concluded that the concept of the death instinct is a clinical and theoretical necessity.     

Comments on the Ikonen & Rechardt paper on the origin of shame

Psychoanalysis is concerned with the unconscious; it weaves fleeting connections with it, and studies its effect on the conscious mind. This is the only method which allows us to reach the unconscious, making use of the technique of dream interpretation and free association. The various effects of unconscious impulses take the form of psychic and somatic symptoms and of impulsive behavior. The psychoanalytic method should enable the analysand to make contact with the veiled meanings of the repressed self, above all with its strivings. Simultaneously, the origins of poorly-functioning psychic structures are also revealed. Psychoanalysis also needs to examine the varying potential of the patient to benefit from analytical work and arrive at a better understanding of his or her unconscious mind. We have seen, as Freud did in his time, that the benefit derived from analytical understanding, i.e., interpretation, is by no means self-evident. In the mental structures of patients, we encounter aspects which reject the integrating effect of the analytical understanding. This finding, the so-called negative therapeutic reaction, and the more detailed psychoanalytical study of its contents and the psychic functions and structures involved, has made psychoanalysis every year more and more challenging and interesting.