Report on a Panel Discussion on Interpretation

A case is presented where the patient's early experiences of violence and neglect have resulted in a defensive organization that has protected him against intolerable anxiety, at the cost of development and growth. In the analytic setting, the patient withdrew into his perverse fantasy world, an area of relative peace where he had omnipotent control, whenever contact with the analyst within a “room for relatedness” was experienced as threatening or frustrating. His avoidance of contact with the analyst was also an avoidance of reality, and proved to be a strong obstacle to progress in the treatment. During the terminal phase, he was forced to face reality and it seemed then that some widening of his psychic reality took place.     

Collusive induction in perverse relating: Perverse enactments and bastions as a camouflage for death anxiety

The author argues that one of the main functions of perverse relatedness is to induce the analyst into becoming the patient's unconscious accomplice in a “perverse pact” against the analytic work aimed at disavowing intolerable aspects of reality. The intense power of collusive induction in perverse relating leads the analyst to participate in transference‐countertransference enactments and to the crystallization of a silent and chronic unconscious collusion between the patient and analyst in the analytic field, stagnating the process (bastion; Baranger and Baranger). The author claims that analysis of perverse pathology should not be limited to interpretation of the patient's intrapsychic functioning but should also focus on the information obtained by the analyst through his participation in collusive enactments; the analyst should also take a “second look” at the analytic “field” to detect underlying bastions. The author reviews the main psychoanalytic contributions that have clarified the phenomenon of collusive induction in perverse relating and as an illustration, describes the analysis of a man with a perverse character; in this patient, one of the main functions of his perverse relatedness was to induce the analyst to become an accomplice in his disavowal of his terror of death. The author highlights the influence of death anxiety in the bastions that develop in the treatment of perverse patients.     

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.     

Method for examining children's beliefs about the functional role played by defensive interpersonal behaviour

The goal of this study was to develop a method for examining children's expectations about the short‐term consequences of defensive interpersonal behaviour. We employed the theory of interpersonal defence (Dahmen & Westerman, in press; Westerman, 1998, 2005 ; Westerman & Prieto, 2006 ), an interpersonal reconceptualization of defence processes, as the framework for this method. We developed a two‐part procedure for eliciting children's responses to closed‐ended and open‐ended questions about interpersonal vignettes presented in storyboard format, and we employed this method in a preliminary investigation with a sample of 62 intellectually gifted boys and girls aged 7–8 and 10–11. The results showed that the participants understood that defensive interpersonal behaviours affect the likelihood that feared and wished‐for short‐term outcomes will occur. Participants demonstrated that they understood that people behave defensively in order to avoid feared consequences and nondefensively in order to pursue wished‐for outcomes. Findings also indicated that older participants understood that a person is more likely to behave defensively in highly conflict‐ridden situations. The results suggest that our method provides the basis for research that complements previous studies of children's understanding of how intrapsychic defence mechanisms regulate a person's affective experience. Future research using this method could investigate the role of beliefs about defensive behaviour in the development of behaviour problems.     

From pilot fish to analyst: Finding a path between symbiotic and autistic defences

This paper presents the clinical case of a patient with autistic features. One of the main difficulties in his treatment was the particular rapid rhythm of his projections, introjections and re‐projections that constrained the analyst's capacity for reverie and hindered the use of effective projective identification processes. These alternating defensive constellations lead either to an expelling autistic barrier or to an engulfing symbiotic fusion. Their combination can be seen as the expression of a defence against an unintegrated and undifferentiated early experience of self that was in this way kept at bay to prevent it from invading his whole personality. Maintaining the symbiotic link, in which I kept included by staying partially fused to what was being projected and using my analytic function in a reduced way, helped to relate to what was in the patient's inside. Leaving this symbiotic link let my interpretations appear to ‘force’ their way through the autistic barrier. Yet as the process developed they allowed to show the patient how he ejected me and what was happening in his inside, behind his autistic barrier. So I found myself on the one hand accepting the symbiotic immobilization and on the other hand interpreting in a way that seemed forced to the patient, because it implied a breaking of the symbiotic position. The inordinate speed of projections and introjections could thus be interrupted, creating a space for awareness, reflection and transformation, and allowed the emergence of a connection between the patient's inside and outside. In the course of treatment I realized that this kind of dual defence system has been described by the late Argentinian analyst José Bleger. He assumes the existence of an early “agglutinated nucleus” that is held together by a psychic structure he calls the “glischro‐caric” position, in which projective identification cannot take place because there is no self/object differentiation. I have considered the rapid and fugitive use of projection and re‐introjection I met in my patient to be a manifestation of the dual defence system Bleger describes. Although he does not specifically mention this particular vicissitude of operative defences he does give hints about a rhythm in the patients’ projections and introjections.     

Le genou de Clémence ou l'espace nostrique comme perspective psychothérapeutique

The writer uses the case study of Clemence' knee to present the phenomenological concept of Wirheit in german (Nostrité in french) which can be translate into "being with" or "being together" in english. This concept is worth knowing in psychology because it can run the psychotherapeutic treatment more effective: care proceedings which will be able to create their own "being with" area vill start again the existential dimension of the patient; this sentient and unrepresentable (so unanalysable) base of the psychical human identity. In practice, we'll see that this therapeutic « being with » consists in working a spontaneous problematic "being with" called out by the patient. This defensive position can be identified in the light of a cover for the human being core. With the therapeutic help, such a "being with" will become the place of the embodied and incorporated self as a competent base for existence. It is noteworthy that the method used to make the reader's understanding easier is to start from a psychanalytic understanding of Clemence's problematic to move on a phenomenological one, so as to draw the efficient sight, for psychology, of this "being with" concept came from philosophy.     

Self-Determination, Wellbeing, and Threats of Harm

David Rodin argues that the right of national‐defence as conceived in international law cannot be grounded in the end of defending the lives of individuals. Firstly, having this end is not necessary because there is a right of defence against an invasion that threatens no lives. However, in this context we are to understand that ‘defending lives’ includes defending against certain non‐lethal threats. I will argue that threats to national‐self determination and self‐government are significant non‐lethal threats to the wellbeing of individuals that can justify lethal defensive force. Therefore the end of defending individuals can ground a right of national‐defence against a ‘bloodless invasion’. Secondly, Rodin argues that defending lives is not a sufficient condition for military action to be national self‐defence, because humanitarian intervention is military action to defend individuals, and such action is in deep tension with national self‐defence. I will argue that a reductive account, grounded in claims of need and threats of harm, can justify principles of both intervention and non‐intervention on the same grounds; that is, protecting the wellbeing of individuals.     

Elements of the Oedipus complex: A Kleinian account1

The author discusses and illustrates the place in current Kleinian practice of the analysis of the Oedipus complex. He outlines the development of the concept of the Oedipus complex by Freud and by Klein and later writers in the Kleinian tradition. Because the child's exclusion from his parents' sexual relationship represents such a fundamental aspect of reality for the child, analysis of the patient's responses to the oedipal situation constitutes the central task of analysis. Despite the Oedipus complex being in this way central, it is sometimes hard to discern because what is most visible are the patient's defensive responses to the oedipal situation. The emergence of meaning in analysis is often understood unconsciously as the product of the parental intercourse, represented by the work of the patient with the analyst, or of the analyst's or the patient's mind. The analysis of the patient's characteristic reactions to moments of meaningfulness in analysis is therefore an especially fruitful focus for the analysis of the Oedipus complex. The author illustrates these ideas by three clinical examples, from a 3½‐year‐old child, a borderline psychotic patient and a more neurotic patient.     

Discussion of Presentation by Joseph Newirth

Discussing Joseph Newirth's case from a modern Freudian perspective, I explore possible sources of the patient's degraded view of herself, her ambivalent feelings toward men, and her fears of sexuality. I also discuss the course of the treatment, noting that both the patient's progress and the core of her resistance centers on her complex relationship with her analyst. This has been the source of healing and of avoidance of her inner world of imagination and fantasy. I further suggest that active confrontation of the patient's defensive use of her relationship with her analyst would enhance the substantial gains that she has already made.     

A psychoanalytical phenomenology of perversion1

After stating that the current tasks of psychoanalytic research should fundamentally include the exploration of the analyst's mental processes in sessions with the patient, the author describes the analytical relation as one having an intersubjective nature. Seen from the outside, the analytical relation evidences two poles: a symmetric structural pole where both analyst and patient share a single world and a single approach to reality, and a functional asymmetric pole that defines the assignment of the respective roles. In the analysis of a perverse patient, the symmetry‐asymmetry polarities acquire some very particular characteristics. Seen from the perspective of the analyst's subjectivity, perversion appears in the analyst's mind as a surreptitious and unexpected transgression of the basic agreement that facilitates and structures intersubjective encounters. It may go as far as altering the Aristotelian rules of logic. When coming into contact with the psychic reality of a perverse patient, what happens in the analyst's mind is that a world takes shape. This world is misleadingly coloured by an erotisation that sooner or later will acquire some characteristics of violence. The perverse nucleus, as a false reality, remains dangling in mid‐air as an experience that is inaccessible to the analyst's empathy. The only way the analyst can reach it is from the ‘periphery’ of the patient's psychic reality, by trying in an indirect way to lead him back to his intersubjective roots. At this point, the author's intention is to explain this intersubjective phenomenon in terms of metapsychological and empirical research‐based theories. Finally, some ideas on the psychogenesis of perversion are set forth.     

The trauma of attempted suicide

Suicide is a traumatic event, one which may acutely recreate a previously-experienced traumatic situation. The person's capacity to think after a failed suicide attempt is affected by the use of defence mechanisms against persecutory anxieties and depressive pain, and there is a wish to turn a blind eye to the seriousness of the suicidal act. This includes the damaging effects on the person's relationships with others, and damage to his own psychic integrity.

The need to turn a blind eye to the consequences of a failed suicide attempt may also be mirrored by the therapist who assesses and treats the patient in the early hours after such an event. Suicide is associated not only with the pain of despair but also with a ruthless abandonment of life. It is a complex and difficult task for a therapist in the immediate aftermath of a suicide attempt to be able to keep in mind a concept of suicide that includes both the patient's role as the perpetrator of great violence against himself, in which death is the intended outcome of his actions, and at the same time recognise the patient's identification with an abandoned and cruelly treated object.

In this paper, we describe some of the psychodynamic factors that affect and influence the assessment and treatment of patients in the immediate period following a failed suicide attempt. We emphasise the importance of supervision in helping prevent destructive acting-out by the therapist when treating disturbed patients under such painful circumstances.     

Female perversion: scenes and strategies in analysis and culture

The author presents some ideas derived from observation in analysis about differing positions of Freud and Jung on perversion and about probable differences in perverse structural elements of women in contrast to men. In general perversion is understood as a defence of the self; in particular with women it is seen as a defensive way of achieving a false wholeness, a pseudo-androgyny. A case study describes the unfolding of a perverted transference. The importance of reaching the analyst and being understood by the analyst through projective identification is stressed. Quite often a sexually abusing mother seems to play an important role in generating female perversion; the implications in analysis are discussed as well as some ideas about culture and gender.     

The analyst's excitement in the analysis of perversion

The author believes that unconscious sexual excitement in the transference and countertransference is an especially problematic aspect of the analysis of perverse character pathology and that perverse sexual gratifi cation deserves a more prominent position in the clinical theory of analyzing perversion than that which has been assigned tacitly through analysts' routine focus on the defensive and destructive dynamics of perversion. He presents clinical material from the analysis of a perverse patient that illustrates the role of excitement in the transference perversion established in this analysis; and he asserts that gratifying perverse enactments occurring in the transference perversion can appear not only as conscious or unconscious excitement in the transference but also, at times most clearly, as the analyst's excitement. The author suggests that using a clinical theory that supports the analyst in understanding his excited responses as perverse countertransferences-i.e. evoked excitement complementary to the sexual component of a perverse transference-will assist him in locating and thinking about gratifying, perverse excitement in the transference where it is most usefully analyzed. Finally, he discusses some of the reasons why analysts might deny, suppress or otherwise avoid perverse countertransferences and in so doing contribute to sustaining perverse resistances.     

Interpretive acting-out: Unavoidable and sometimes useful

Abstract

Using one detailed case presentation, this paper examines the clinical hardship of making accurate and helpful interpretations that do not become part of the patient's defensive system. The author argues that interpretive acting-out is inevitable in the psychoanalytic process. But, if properly monitored, understood, and contained, these interpretive enactments can sometimes actually be a profit to the overall treatment. Issues of projective identification, countertransference, and the importance of realizing our transference role in the patient's changing phantasies are discussed throughout the case material.     

A Kleinian view of psychoanalytic couples therapy: Part 2

With extensive case material, Part 2 continues to explore the psychoanalytic treatment of couples. Since most couples enter treatment operating in a more primitive paranoid‐schizoid stance, the author contends that it is best to initially focus on each partner's pathological projections and have the other partner witness their struggle to overcome personal issues that contaminate the couple's unified psychology. With continuous working through, the couple can gradually find a more depressive, integrative footing within themselves and as a couple. Again, the value of ‘witnessing’ and working through individual defensive reactions against thinking, pathological projective identifications and the breakdown of the container‐contained function are all examined in the clinical presentations. All these clinical elements are part of the establishment of analytic contact first with each party as individuals and later as a unified couple.     

From the perverse pact to universal conflicts

We psychoanalysts – as split subjects – are not immune to charismatic leaders who preach violence against selected targets depicted as the cause of all evils. Freud, in Group psychology and the analysis of the ego, alerted us against such leaders, who can manipulate by transforming us into an uncritical mass. This would be the social equivalent of the perverse pact in repressive desublimation between the superego and the id at the expense of the ego: the latter is put to sleep, and the superego exhorts the id to do violence and regress. Socially, these perverse pacts often take place with the superego represented by charismatic leaders who foster identification with themselves, put the egos of their audiences to sleep through manipulation and thus address an amorphous mass that they can direct towards violence and destruction. An event in which such a phenomenon apparently occurred will be discussed to show how urgent it is to revisit psychoanalytic writings on these matters in order to withstand the temptation to be herded by manipulative leaders. This will certainly protect psychoanalysis and allow for its transmission. It is up to us to exercise the critical analysis that psychoanalytic tools equip us for so that we can detect such summons to perverse pacts and denounce them.     

Three Phases of Treatment with Borderline and Psychotic Patients

Three distinct, yet overlapping, phases of treatment emerge when working with some borderline and psychotic patients. This are patients who test the ordinary limits of psychoanalysis, but can profit from its deep exploration. The first phase is colored by acting out, interpersonally and intrapsychically. An analytic envelope of containment is necessary to sustain the treatment. Interpretive holding and containing help the patient find a psychic receptacle capable of detoxifying violent projections. Many of these patients terminate prematurely. The second phase is centered around the patient's defensive use of the death instinct to extinguish or destroy certain parts of their mental functioning. This difficult standoff between parts of the patient's mind becomes replicated in the transference. The third phase reveals the more fundamental problem of paranoid～schizoid anxieties of loss and primitive experiences of guilt. These include fears of persecution and annihilation. Some patients abort treatment in the first or second phase and never work through the phantasies and feelings of loss. Nevertheless, much intrapsychic and interpersonal progress is possible. Given the instability and chaotic nature of these patient's object relations, the analyst must be cautiously optimistic in their work and realize the potential to help the patient even when presented with less than optimal working conditions.     

The internal world of the juvenile sex offender

This paper explores the consequences of the therapist's two successive pregnancies on a female patient. The second pregnancy was felt to be particularly difficult and disturbing. One of the central reasons was that after the patient's birth, the mother had a disabled child, followed by a stillbirth and soon after that the father left to marry another woman. Using Freud's concept of deferred action I will argue that my second pregnancy revised these earlier traumatic experiences.

The patient seemed to have incorporated and identified with a damaged maternal object that at the time of the original trauma was left husbandless, depressed and suffering from panic attacks. Although the therapist's healthy pregnancies seemed to reassure temporarily, it was difficult for the patient to hold onto a view of a helpful and productive therapist, one separate from this damaged internal mother. This was particularly so during and after the second pregnancy, where there was a marked absence of an idea of a third object, a father or a husband, who could help the patient deal with this pregnancy, her only escape was to retreat and act out.

The acting out was in part identification with a fleeing father and in part a defence against the absence of such a third object, so that it was used as a way of avoiding claustrophobic feelings of being trapped with the damaged mother. Her feelings of triumph then produced much guilt, and impeded reparation.

Another important issue that two successive pregnancies bring, are feelings of guilt in the therapist for exposing the patient to two major disruptions. In this patient's case it exacerbated the internal reality of a damaged maternal figure.