The analyst's trust and therapeutic action

The analyst's trust, a neglected topic in psychoanalytic discourse, participates in therapeutic action--through the analyst's emotional openness, "unobjectionable positive counter-transference" (see Fox 1998), the holding environment, and the promoting of adaptive internalizations, among other ways. When the analyst's trust--in the patient, in the analyst's self, and/or in the psychoanalytic process--fails, crucial interactions may occur, capable of destroying treatment, or alternatively, of restoring mutual regulatory functions and potentially leading to important mutative processes. Patients benefit from analysts' becoming sensitive to, having useful ways of thinking about, and working with their states of trust and distrust. The author presents clinical examples to illustrate these points.     

Psychoanalytic action explanation

Psychoanalysis is concerned with neurotic behaviour that counts as an action if one takes into account “repressed” mental states. Freud's paradigmatic examples are a challenge for philosophical theories of action explanation. The main problem is that such symptomatic behaviour is, in a characteristic way, irrational. In line with standard interpretations, I will recap that psychoanalytic action explanation is not in accordance with Davidson's classical reason-explanation model, and I will recall that Freud's unconsciousness is not a second mind with its own rationality but that it is non-propositional in character. However, I then will argue that this characterization is not discriminating enough to explain the dynamical unconscious and overlooks the crucial role of “counter-cathexis”. With counter-cathexis the relevant desire turns out to be a complex with two inseparable aspects (“double-aspect view”), so that the causing belief–desire pair is still part of the space of reasons, although it cannot rationalize the behaviour. Psychoanalytic action explanation is hence still Davidsonian, albeit in a modified way.     

A socioeconomic dimension of the therapeutic relationship the analyst's perspective

Abstract

Gojman de Millan S. A Socioeconomic Dimension Of Therapeutic Relationship. The Analyst's Perspective. Int Forum Psychoanal 1997;6:241—249. Stockholm. ISSN 0808-706X.

Two clinical vignettes are described. I wish to show how much an open recognition of the social conditions of both participants in a treatment process may enrich the analyst's understanding of the transference-countertransference dynamics. I claim that although analysts intuitively integrate this aspect of the therapeutic relationship they commonly do it without a specific formulation.

In an explicit and systematic manner, Fromm emphasized the social dimensions of human experience. His background knowledge of the social sciences framed his therapeutic practice. The clinical implications which derive from this perspective will be illustrated.

The clinical material which I present shows how today's psychoanalytic attention to the dynamic interaction between analyst and patient while it enables us to deal with the complexity and different layers of the treatment process can also include the social dimension. The benefits and difficulties of developing our consciousness about our own social roles and our involvement in the social milieu deserve our careful and critical attention.     

Neutrality,tenderness and the analyst's subjectivity

Addressing the rôle of the analyst in the psychoanalytic relationship, the author takes issue with the emphasis on acknowledging the analyst's subjectivity and the critique of concepts like neutrality and abstinence as these issues are presented in the relational tradition. He advocates a better articulation and emphasis of these concepts in the service of understanding the impact of the analyst's subjectivity, and demonstrates how the mere loosening up of analytic neutrality and abstinence and an acceptance of the analyst's self-disclosure make transference analysis more difficult to handle. Such an attitude also increases the risk for ethically dubious conduct, since there is a close link between clinical methods and ethical standards in psychoanalysis. In conclusion, the author points to the importance of the analyst's continuous self-reflection and countertransference analysis.     

Privacy, reverie, and the analyst's ethical imagination

The author illustrates varying ways of using and thinking about forms of analytic reverie and the analyst's privacy. He discusses a few different registers from which the analyst can illuminate points of transference-countertransference enactment. The modality by which the analyst communicates these formulations of unconsciously held object relations and defenses varies and includes verbal interpretation through symbolic speech, interpretive action (Ogden 1994a), and, at times, interpretations that involve a construction of the analyst's subjectivity put forward to enhance the patient's understanding of enactments of the transference-countertransference. The author develops a concept, the analyst's ethical imagination, defined as the ways in which we consider and anticipate the implications of our interpretations.     

On the analyst's neutrality

It is by the application of the principle of neutrality, born of his respect for the essential otherness of the patient, that the analyst focuses the dyadic analytic work in the service of the patient's growing self-analytic capacity. Thus, the general principle of neutrality is distinguished from the technical tactic of abstinence, the latter being a specific function utilized to facilitate and foster analytic regression. Neutrality can be defined as it applies to the major subfunctions of the analyst's work ego. Perception of the patient's intrapsychic processes (both empathically and cognitively) requires a neutrality of appearance on the analyst's part in order to minimize the distortion of the unfolding transference neurosis. Integration and understanding of the patient's communications require mastery and neutralization of the analyst's own internal processes in order to minimize countertransferential distortions. Appropriate interpretive intervention requires neutrality of action, i.e., mastery of impulses related to power, neutralizing them into the service of the analytic work; tact is defined as a specific psychoanalytic function in this regard. Collaborative ignorance is examined as a specific instance of false neutrality. In this an analytic guise serves to mask a countertransferential conflict. Neutrality serves as an overriding technical principle, not an imperative for perfectionism . Factors intrinsic to the analytic process also influence the application of this principle.     

Infants track action goals within and across agents

The ability to understand that goals and other intentional relations are attributes of individual people is of fundamental importance to social life. It enables us to predict and interpret actions on-line by relating a person's prior and current behaviors, and distinguishing them from the behaviors of other persons. In this paper, we consider the origins of the ability to mark goals as attributes of individual people. Using a visual habituation paradigm to assess infants' tracking of goals, we tested whether infants represented goals are specific to particular agents. Thirteen-month-old infants restricted reaching goals to particular agents, but generalized a conventional linguistic action, labeling, across agents. Nine-month-old showed the former pattern but not the latter. We discuss these findings in the context of developing understandings of person specific and person general action knowledge.     

Psychoanalytic psychotherapy in paediatric liaison: a diagnostic and therapeutic tool

Paediatric liaison work requires an appreciation of the interweaving of the different factors involved when a child has physical symptoms. Psychoanalytic psychotherapy is usually viewed simply as a potential treatment option. This paper argues that its use is both therapeutic and diagnostic and that it should be valued for this breadth of contribution. The therapeutic process is conducted in a way that can promote an understanding of the child and their context and thus enhance the ability 9 to meet the child's needs by all involved in their care. This can be achieved without sacrificing the degree of privacy that the psychotherapist/patient relationship requires. Material is presented from the psychotherapy of a child who had an hereditary condition which moved unexpectedly into a terminal 2 phase after psychotherapy was started. Examples are given to illustrate the importance of the understanding gained from therapy and how, through an integrative process, it was used to assist the overall 4 care. The material also describes the potential diagnostic use of information from psychotherapy when this is formulated by consideration of conscious and unconscious mechanisms alongside mental state phenomenology. This has implications for the relationships between disciplines and for their training requirements.     

Rethinking therapeutic action

Like other core psychoanalytic constructs, the theory of therapeutic action is currently in flux, as theorists of differing persuasions propose different mechanisms. In this article, the authors attempt to integrate developments within and without psychoanalysis to provide a working model of the multifaceted processes involved in producing change in psychoanalysis and psychoanalytic psychotherapy. A theory of therapeutic action must describe both what changes (the aims of treatment) and what strategies are likely to be useful in facilitating those changes (technique). The authors believe that single-mechanism theories of therapeutic action, no matter how complex, are unlikely to prove useful at this point because of the variety of targets of change and the variety of methods useful in effecting change in those targets (such as techniques aimed at altering different kinds of conscious and unconscious processes). Interventions that facilitate change may be classified into one of three categories: those that foster insight, those that make use of various mutative aspects of the treatment relationship and a variety of secondary strategies that can be of tremendous importance. They propose that, in all forms of psychoanalytic treatment, we would be more accurate to speak of the therapeutic actions , rather than action .     

The quality of the analyst's attention

Compiled and edited from lectures on psychoanalytic technique given by the late Karen Horney at the American Institute for Psychoanalysis during the years 1946, 1950, 1951, and 1952. Further lectures in this series will appear in subsequent issues of the Journal.     

The analyst's witnessing and otherness

The analyst's active though silent witnessing of the patient's self-inquiry is presented as an essential aspect of the analytic process. Witnessing, though rooted in the analyst's empathy and holding, represents a more advanced development of those functions based on relational muturation from union to self-other differentiation. Self-definition and regard for otherness are seen as intrinsically unitary. Psychoanalytic witnessing is first illustrated and defined, then located as a derivative of negation in the unfolding of the analytic process, next considered in relation to current concerns for intersubjectivity, and finally linked to current shifts in philosophical thought.     

Limit setting and the analyst's working through

The American Journal of Psychoanalysis -     

Blocked goals, persistent action: Implementation intentions engender tenacious goal striving

Research on goal attainment has demonstrated that people are more likely to reach their goals when they form implementation intentions. Three experiments tested whether implementation intentions lead to tenacious goal striving following blockage of an initial attempt to reach the goal. In all three experiments some participants were instructed to form an implementation intention and other participants were not. Subsequently, the initial goal-directed attempt of all participants was unexpectedly blocked. Experiment 1 found that implementation intentions resulted in more attempts to realize one’s goal. Experiment 2 showed that when participants formed an implementation intention their repeated attempt was acted out as intensely as their first, blocked attempt. Experiment 3 found that implementation intentions still allow people to seize an alternative, more onerous means to realize their intention. These results imply that implementation intention conserve self-regulatory strength. After goal blockage, the remaining strength can be used to continue goal-directed action.     

Grasp cueing shows obligatory attention to action goals

To understand the grounding of cognitive mechanisms in perception and action, we used a simple detection task to determine how long it takes to predict an action goal from the perception of grasp postures and whether this prediction is under strategic control. Healthy observers detected visual probes over small or large objects after seeing either a precision grip or a power grip posture. Although the posture was uninformative it induced attention shifts to the grasp-congruent object within 350 ms. When the posture predicted target appearance over the grasp-incongruent object, observers' initial strategic allocation of attention was overruled by the congruency between grasp and object. These results might help to characterize the human mirror neuron system and reveal how joint attention tunes early perceptual processes toward action prediction.