From acting to communicating: The analysis of a boy with a pathological organization1

The author presents the analysis of an 8 year‐old boy prematurely born after a high‐risk pregnancy, then hospitalized for two weeks. He was never breastfed and presented vomiting, intense activity and inadequate behaviour as symptoms. His highly dysfunctional family is composed of a non‐productive father and a homely, though aggressive, mother. The patient displayed a rigid defensive structure with perverse aspects and a cruel superego. His constant interest in magical characters frequently disguises an avoidance of reality. By means of transference interpretations, a trustworthy link with the analyst now allows him his own mental space, where hidden psychotic states come to light. In the clinical material, this boy's skills for insight mingle with oscillations from severely defensive states to integration and vice versa. The analytic relationship in this often hostile scenario has become strong. The analysis is hampered by constant demands from family and school‐both expect the analyst to prevent his frequent acting out. Whereas some perverse polymorphism is part of childhood and may persist throughout life, it is likely that the patient's pathological organization may yield to reality and facilitate reparation, relinquishing the world of make‐believe as well as the intense projective mental functioning.     

Knowledge and experience of time in primitive mental states2

The author proposes that time be considered an object of working through during the psychoanalysis of patients whose mental functioning reveals distinct primitive aspects. These so‐called ‘difficult patients’ are particularly intolerant of the temporal limits of analytic sessions and often attempt to undermine the analytic setting. He presents some hypotheses about time and the mind's depth levels. A series of clinical vignettes taken from the analysis of adolescent, borderline and psychotic patients shows several ways in which the analysand's perception of and relation to time surfaces and is worked through in the course of analysis. Analyzing the relationship with time and the conflict between denial and acceptance of temporality proved a significant catalyst in the development of cases that had tenaciously impeded progress. It thus became possible to bring about important changes in the ways such patients experienced affect in the analytic relationship and in object relations, not by acting directly upon these relationships but by working instead on the formal parameters that organize the mind–and primarily on its spatio‐temporal organization.     

Mental models and language registers in the psychoanalysis of psychosis: An overview of a thirteen‐year analysis2

The author suggests that the use of mental models and language registers may help an analysis to proceed, especially in psychosis, when the patient has not yet developed a mental space that will allow him/her the functions of knowledge and containment of emotions. Models, according to Bion, are a primitive approach to abstraction and a manifestation of the analyst's reverie that enables him/her to transform sense data into alpha‐elements. Ferrari, in a further development of Bion's theories, hypothesises a relationship between the transference and the internal level of body‐mind communication, and proposes the use of language registers to sustain the psychoanalytic process. The author presents several clinical examples from a thirteen‐year, four‐session‐a‐week analysis of a psychotic analysand who was initially confused, paranoid and altogether unable to bring self‐reflective thought to bear on her overwhelming emotions and had, by the end of the analysis, completely recovered from her psychotic symptoms. The clinical material shows how the technical tools of mental models and language registers helped in the construction of a mental space and spatio‐temporal parameters, permitting the patient to tolerate overwhelming concrete emotions and finally to recognise and work through the emotions of an intense transference.     

On shame,countertransference, and analytic style

Some analysands experience a restricted space in the analytic situation with special counter-transferential consequences. The author discusses how shame is involved in these situations, and projected on to the analyst. This leads to an important choice of direction for the analyst regarding counter-transference acting out or conditions for a real analytic situation. Shame plays a special rôle in these choices of direction. The author illustrates the problem with a clinical vignette and shows how integration of shame is accomplished clinically, and continues with a discussion of the connections between the analyst's analytic style, his own communicative style as a defense against shame and the analytic styles of different analytic “schools”. A discussion of Liberman's concept, of “asymmetrical dialogue” and its connection with countertransference acting out and analytic styles, forms a conclusion to the paper.     

Infant observation: A range of questions and challenges for contemporary psychoanalysis1

The author attempts to integrate several perspectives within the field of infant observation that reflect the analyst's personal experience as a clinician, as a professor at the analytic institute and as a researcher in the field of psychoanalysis. Can infant observation contribute to analytic technique, theory and training? If so, what would be the nature of such contribution? To answer these questions, the author reviews the literature on infant observation from Freud to the present, highlighting Latin American contributions to this subject. She makes reference to the role of technological innovations, which have allowed videotaping, repeated observations, temporal segmentation and computerized programs, thus giving rise to microanalytic research. This discussion prompts the question about the contributions made by systematic research to clinical practice. To tackle this question, the author presents both a clinical vignette taken from her personal experience, and the current debate on this subject as it appears in the work of Daniel Stern and André Green. Finally, she presents some conclusions that are part of an ongoing debate in the psychoanalytic field.     

Full and empty spaces in the analytic process2

In this paper the author discusses two categories of patients which differ in terms of the impact they have in the countertransference. On the one hand, there are patients who create an empty space in the analyst's mind. The response they provoke is a kind of depressive feeling that remains after they leave. The patient may bring dreams and associations, but they do not reverberate in the analyst's mind. The experience is of dryness, a dearth of memory, which may‐at times‐leave the analyst with a sense of exclusion from the patient's internal world. At the other extreme, there are patients who fill the consulting room. They do that with their words, dreams and associations but also with their emotions and their actions. The experience is that the analyst is over‐included in the patient's world. They have dreams that directly refer to the analyst and the analyst feels consistently involved in the patient's analysis. The pathway through which the analyst can understand both these types of patients is via the countertransference or, to put it another way, the analyst's passion. In ‘Analysis terminable and interminable’ Freud suggested that the bedrock of any analysis is the repudiation of femininity. The author believes this statement may be viewed as lying at the crossroads of the discussion about the limits of the theoretical and clinical psychoanalytic formulations which she refers to. In the examples presented the author relates the repudiation of femininity in its connections to the gaps implicit in psychoanalytic understanding.     

Reflections on the setting in the treatment of adolescents1

The author focuses on the signifi cance of the setting for the development of the psychoanalytic process, especially in the case of adolescents who request analytic treatment. Her main goals are to specify: a) how the setting is confi gured with this type of patients; and b) to what extent it contributes to the creation of an inner space that may internalize a fi gure with reverie‐a good object that will metabolize the bad and thus enable identifi cation. The setting, which is considered the necessary context for analytic work, is defi ned as bearing two facets: that of the analyst, which must be constant and stable, and that of the adolescent, which will progressively change provided that the analyst maintains a fi rm context that contributes to make the adolescent feel contained and accepted. It is such a feeling that will enable the unfolding of the analytic process. The author emphasizes the importance of the presence of the analyst (his or her voice, the manner of his or her speech, and so on), and the need for the analyst to comply with the rules he or she has established together with the patient. She presents a clinical case to illustrate this conceptualization.     

Analytical space and work in Russia: Some remarks on past and present1

In this paper, the author outlines the historical‐cultural picture in the former USSR and post‐Soviet Russia. He looks at some facets of psychoanalysis in Russia in the years immediately before and after the October Revolution as well as in its recent history, exploring the implicit question of how the wider social context, and specifi cally totalitarian and post‐totalitarian reality, has infl uenced psychoanalytic work and analytic space in this country. With the help of Sebek's concept of the totalitarian object and Britton's formulations about the triangular space, the author attempts to understand the interaction of external and internal space and to give an introduction to the problem of establishing the analytic setting as well as fi nding some new possibilities of enlarging the space for new psychoanalysts in Russia.     

THE VALUE OF UNCERTAINTY

The author discusses some of the characteristics of Roy Schafer's contributions to psychoanalysis that he finds most valuable, such as his openness to uncertainty, his anti‐reductive view of analytic constructions, his unique formulation of the analyst's role, and his close attention to how the patient engenders particular emotional reactions in the analyst. The author also presents a clinical vignette illustrating the value of the analyst's tolerance of uncertainty in the face of the patient's push for interpretations, explanations, and reassurance.     

Flexibility of the Psychoanalytic Approach in the Treatment of a Suicidal Patient: Stubborn Silences as “Playing Dead”

The author presents the clinical case of a patient in his third analysis who seemed emotionless, did not feel alive, and complained of an uncontrollable urge to gamble, with disastrous financial results. His previous four-session-a-week “orthodox” analysis had left him prey to a sense of emptiness and to intense suicidal urges. He wanted only two weekly sessions, which became three after some analytic work. The author stresses the danger of rigidly following inflexible standards and the consequent activation of a pseudo-compliance in the analysand. A more slowly paced psychoanalysis should not be considered lower in the pecking order than “high-frequency” treatment, the author maintains: It requires great creative subjective involvement on the part of the analyst and close interaction in the context of the analytic couple. The author shows how this analysis involved a series of interactions in which the analyst was called upon to exercise a complex responsiveness, attuned in each instance to the patient's current needs. Finally he focuses on some clinical passages to show how the patient's internal theories represent a glaring assault on common sense and how death was not recognized perceptionally on a realistic level, but was instead replaced with acting out death against himself by keeping himself mentally dead and by suicidal urges.     

I Am My Brother's (and Sister's) Keeper: Jewish Values and the Counseling Process

The author writes a rejoinder to M. S. Kiselica's (2003) article “Anti‐Semitism and Insensitivity Toward Jews by the Counseling Profession: A Gentile's View on the Problem and His Hope for Reconciliation—A Response to Weinrach (2002),” which is part of a dialogue in the fall 2003 Journal of Counseling & Development on anti‐Semitism in the counseling profession. M. S. Kiselica supports the notion that Jewish concerns are inextricable from multicultural counseling. The author has asserted that there has been a critical mass of anti‐Semitic behavior within the counseling profession, including the American Counseling Association, for more than 3 decades. The author's perspective may be viewed as an application of the Torah's dictum “I am my brother's [and sister's] keeper.” The author also argues that while culture may influence behavior, it does not determine it exclusively.     

Beyond transference,countertransference, the silences and the opinion1

The author examines several works of an intersubjectivist trend, as well as writings by Hanly, Cavell and Bion, defending many of the named psychoanalysts' viewpoints. These viewpoints are expressed in the search and the struggle for truth, recognizing, like Popper, that truth exists but that we cannot know with certainty whether and when we touch upon it, only that this endless effort merits a lifetime's work because it is the attempt at an encounter with ourselves‐the true encounter. The author explains the criticisms by Green of Jacobs, and defends the maintenance of ‘a certain possible neutrality’ (Eizirik). He poses some questions with regard to Ogden's ‘third subject’, considering it, among other aspects, from the supervisory point of view, which may demonstrate the existence of ‘a certain possible objectivity’ of the emotional confl ict. He develops some criticisms concerning silence as an interpretative action by Ogden, and summarizes two case histories. Both were unconsciously attempting to manipulate the analyst intensely‐one of them to get the analyst to intervene in his love life, and the other to interrupt acting out.     

The Role of Theistic Spirituality in Adolescent Girls' Body Esteem: A Pilot Outcome Study

A pilot outcome study explored associations between psychospiritual variables and body esteem in adolescent girls at a Roman Catholic high school by examining the influence of The Imago Dei Experience (TIDE), an intervention program the first author designed. Perception of God's loving acceptance accounted for significant variance in weight and appearance body esteem; religious crisis accounted for significant variance in weight body esteem. Lack of significant changes in body esteem from pretest to 18‐month follow‐up suggested the TIDE program may have buffered the typical increase in body dissatisfaction over that period of time for adolescent girls. The authors recommend counselors explore qualities of God image and religious crisis with adolescent girls.     

On the edge: The psychoanalyst's transference1

Countertransference is a central topic in analytic work and in the literature. The concept of countertransference includes a basic question which has been understood in different ways. The author attempts to differentiate between the psychoanalyst's transference and his countertransference in the analytic process. It is hard to draw a line between them; analysts are always on the edge. The analyst's transference will be explored and described using three approaches: narcissism, regression profile and the analyst's phase of life. Regression profile is a new concept developed by the author, which may help us to understand the core of the analyst's transference in the analytic situation. She illustrates the topic by clinical vignettes.     

THE TRIADIC INTERSUBJECTIVE MATRIX IN SUPERVISION: THE USE OF DISCLOSURE TO WORK THROUGH PAINFUL AFFECTS3

The use of the psychoanalyst's subjective reactions as a tool to better understand his/her patient has been a central feature of clinical thinking in recent decades. While there has been much discussion and debate about the analyst's use of countertransference in individual psychoanalysis, including possible disclosure of his/her feelings to the patient, the literature on supervision has been slower to consider such matters. The attention to parallel processes in supervision has been helpful in appreciating the impact of affects arising in either the analyst/patient or the supervisor/analyst dyads upon the analytic treatment and its supervision. This contribution addresses the ways in which overlapping aspects of the personalities of the supervisor, analyst and patient may intersect and create resistances in the treatment. That three‐way intersection, described here as the triadic intersubjective matrix, is considered inevitable in all supervised treatments. A clinical example from the termination phase of a supervised analysis of an adolescent is offered to illustrate these points. Finally, the question of self‐disclosure as an aspect of the supervisory alliance is also discussed.     

The Last Time: Commentary on Paper by Stuart A. Pizer

Pizer presents poetic details of his patient's complex therapy and analysis. This commentary examines one moment in the treatment that may have violated the potential in potential space. The question is raised as to the impact of such a moment.     

Black and white fire: the interplay of stories,imagination and children's spirituality

This paper explores the potential for using narrative to foster children's spiritual growth. It discusses the nature, origin and appeal of story and presents theoretical perspectives which form a rationale for using non‐sectarian children's, adolescent and young adult literature for spiritual development. Such books avoid church‐and‐state controversies while providing a fresh approach to educators where religious and spiritual education are mandated.     

‘We Pray by His Mouth’: Karl Barth,Erving Goffman,and a Theology of Invocation

Rereading the opening question of the Westminster Catechism, “What is the chief end of man?”, I contend in this essay that the act of invocation — giving God thanks, praise, and petitions — is the act in and through which human being itself is founded, constituted and achieved. I take important cues from Karl Barth's Church Dogmatics and The Christian Life, and from sociologist Erving Goffman's work on the shifting “footings” involved in everyday interactions. I argue for an account of the human being as a being‐with‐God, human acting as acting‐with‐God, and human salvation as a restoration to the genuine human partner's work — indeed, the true leitourgia— of thanks, praise and petition to God.     

Bion and C.G. Jung. How did the container‐contained model find its thinker? The fate of a cryptomnesia

This paper investigates the possible impact of C.G. Jung's Tavistock Lectures on Bion's concept of the living container. In the first part of the paper, the author offers clues pointing to such an essential impact, which can be found in text passages as well as in the facts of the Bion‐Beckett case, up to and including Bion's first publication of ‘The imaginary twin'. The author suggests that cryptomnesia is the result of repression targeting a highly cathected author's communication which functions like a deep interpretation for the recipient, whose new theory then is a return of the repressed content as well as a transformation of it. The second part of the paper investigates the fate of the assumed cryptomnesia. From this point of view Bion's concept of the container in itself appears to be the result of growth in the container‐contained mode. Finally the author deals with the question whether cryptomnesia in psychoanalytical literature can frequently be seen as the result of psychic growth.