Political Divide in the Consulting Room*

This paper addresses a treatment relationship that tests the analyst’s capacity for empathy within an impinging political context. It involves a Ferenczian “relaxation of technique” within the analytic frame, while the analytic couple attempts to negotiate a polarized transference and countertransference. Specifically, within a long-term treatment imbued with positive transference, my patient becomes openly outraged by my insensitive anti-Trump remarks. Increasing confrontations around the expression of political views illuminate our otherness. He complains of psychic ostracism within a liberal cultural context, which tolerates no divergence from mainstream liberal ideas or discourse. I come to embody the oppressive other: the liberal “thought police”, “silencing” him for his perspective. Empathic breaches between us take center stage: how I don’t see the world as he does, and don’t see or hear him.     

Creativity Finds Its Way Into the Psychoanalytic Consulting Room

This article presents an analogy between aesthetic creativity and the creative process in analytic treatment. The analogy is based on the dialogic nature of artistry in creative endeavors and treatment dyads. The openness to multiple realms of input, present and past, and mutual influencing are stressed. Clinical examples and modes of clinical approach are offered in illustration.     

Creativity in the Consulting Room: Factors of Fertility and Infertility

Using detailed clinical material, the author tries to clarify what are the factors, inside the analyst's room, of fertility and infertility for the analytic couple. Concepts from Bion and the Barangers, as well as the concept of the analytic field, provide a frame of theory for the clinical material.     

An Elephant in the Consulting Room: Making Space for a Patient's Secret

Developing a private self is required for healthy development to proceed during childhood. However, when secrecy becomes a way of life, development becomes derailed. Secretiveness crowds out privacy during this critical phase of development for many reasons and the result is a secret self. This articles examines secrecy as an adaptive way to avoid shame, manage isolation, and hold onto the threads of identity, allowing for the preservation of a self. It also examines the ways in which secrecy creates emotional distance and prevents intimacy. To illustrate these ideas, I present my work with a patient who developed a secret self and came to treatment with a secret he has yet to reveal. Known between the therapist and patient as “the elephant in the room,” the secret became and remained central to the work and the therapeutic relationship.     

Analytic Sadism and Analytic Restraint

Csillag challenges us to consider the presence and impact of the analyst’s sadism in the clinical encounter. Her theme usefully adds to the literature on the analyst’s countertransference and pushes us to look harder at ourselves. I distinguish between sadistic intent and experienced sadistic impact and suggest that Csillag is mostly speaking about the latter. Additionally, I address the absence of analytic restraint as a professional ideal that might moderate our slide to sadism in the countertransference.     

The Severe Sexual Sadism Scale: cross-validation and scale properties

The Severe Sexual Sadism Scale (SSSS) is a screening device for the file-based assessment of forensically relevant sexual sadism. The SSSS consists of 11 dichotomous (yes/no) items that code behavioral indicators of severe sexual sadism within sexual offenses. Based on an Austrian sample of 105 sexual offenders, the present study replicated the 1-dimensional scale structure of the SSSS, as evidenced by confirmatory factor analysis. More specifically, the scale was commensurate with the 1-parameter logistic test model (Rasch model). Reliability was estimated to be good. Criterion validity for the clinical diagnosis of sexual sadism was good. With a cutoff value of 7 points, sensitivity and specificity were estimated at 56% and 90%, respectively.     

The Rod of Discipline: Masochism, Sadism, and the Judeo-Christian Religion

Within the Judeo-Christian tradition, the scenario where a person, often a child, is being beaten by a parent, an authority figure, or even God, is often found. This essay searches for an explanation for this phenomenon by combining Sigmund Freud's thoughts on the masochism of the Oedipus complex and Martin Bergmann's belief that Western religion was impacted by the sadism of the Laius and Jocasta Complexes. The paper argues that, within the section of the Judeo-Christian tradition that sanctions the physical abuse of children, sadism and masochism find the perfect marriage.     

Sadism,Penetration, and the Negotiation of Desire: Commentary on Paper by Csillag

The author takes up Csillag’s idea of sadism as the wish to penetrate in the context of a patient who withholds from his analyst. With such a patient, the analyst has to bear the strain stemming from a lack of both satisfaction and recognition–the feeling of not having an impact. The defenses against sadism are examined along with the absence of intentionality in both clinical cases presented, an absence that places sadism in the realm of something that is unconscious or preconscious. Alternative views are offered on the enactment between Csillag and her patient with a focus on the unspoken negotiation of desire and (drawing on Fairbairn) the analyst’s attempt to breach her patient’s closed system of internal objects.     

Consulting the Many and the Wise

Conceived as a solution to clinical dilemmas, and now required by organizations for hospital accreditation, ethics committees have been subject only to small-scale studies. The wide use of ethics committees and the diverse roles they play compel study. In 1999 the University of Pennsylvania Ethics Committee Research Group (ECRG) completed the first national survey of the presence, composition, and activities of U.S. healthcare ethics committees (HECs). Ethics committees are relatively young, on average seven years in operation. Eighty-six percent of ethics committees report that they play a role in ongoing clinical decision making through clinical ethics consultation. All are engaged in developing institutional clinical policy. Although 4.5% of HECs write policy on managed care, 50% of HEC chairs feel inadequately prepared to address managed care. The power and activity of ethics committees parallels the composition of those committees and the relationship of members to their institutions. The role of ethics committees across the nation in making policies about clinical care is greater than was known, and ethics committees will likely continue to play an important role in the debate and resolution of clinical cases and clinical policies.     

The Role of Sexuality in Sadism: Object Relations and Drive Theory Perspectives

The sexual components of sadism are conceptualized within the contexts of different forms of sadism. In aggression-drive sadism, sexuality is seen as a generalization of instinctual reactivity. Parallels are presented of such spillover between aggression and anxiety and even between aggression and oral impulses, with the notion that any areas of excitation or partial impulses can be energized by the acute release of energy in another domain. Another dynamic is presented for re-enactment sadists, in which the sexuality has a relational meaning. In such cases, sexuality is intertwined with the aggression, as the sadistic ritual actually re-evokes an original trauma that features these elements. It is further agued that the sexuality in these two sadistic modes is not consistent. The instinctual spillover that occurs in hostile psychopathy is psychosexually rooted in phallic functioning, in which relational implications are absent, while the sexuality in re-enacted sadism is genitally based, and is intrinsically linked to an imagined emotional relationship with the victim that is intended to ameliorate and undo past trauma that haunt the perpetrator.     

Sadism linked to loneliness: psychodynamic dimensions of the sadistic serial killer Jeffrey Dahmer

In this article the psychodynamic link between loneliness and sadism is examined on basis of a case report of the sadistic and cannibalistic serial killer Jeffery Dahmer. Envy, shame/rage mechanism, a disturbed oral-sadistic development, castration fear and severe feelings of inferiority, the conviction of being unlovable and unacceptable, need to diminish tension, powerful and sadistic fantasies as a consequence of inadequate and frustrated parenting, and reality distortion appear to be involved in sadistic etiology.     

Ordinary language in memoriam

Taking as a point of departure a recently published collection of representative contributions from various philosophers who claim to ‘proceed from ordinary language’, this article examines ordinary language philosophy in the light of some of the claims made by these philosophers. The claims are criticized mainly for failing to account for the variability of the use of terms in respect both of depth of intention and special contexts. These factors are such as to render the claims in question false when interpreted as significant assertions about language, but trivial when they are interpreted as reasonable and true.