Negative oedipal transference of a male patient to his female analyst during the termination phase

There has been some debate in the literature concerning the ability of the male patient to experience his paternal, and particularly negative oedipal, transference feelings directly toward his female analyst. In this context, the author describes paternal transference manifestations evident throughout her male patient's analysis, and presents detailed process material from the termination phase. At this time the patient's obsessional neurosis was revived in the context of setting a termination date, and transference to the negative oedipal father could be clearly demonstrated. The paper illustrates that even the negative oedipal component of the paternal transference can be experienced directly in the male patient/female analyst, dyad, and interpretation of this material can bring it into clearer focus. The author discusses some possible influences of her sex on the timing and intensity of the material.     

Developments in cognitive neuroscience: II. Implications for theories of transference

An integration of psychoanalytic theory with contemporary developments in cognitive neuroscience offers a useful perspective on long-standing controversies about the nature of transference, and a better understanding of the precise mechanisms by which transferential processes occur. Contemporary psychoanalytic views of transference are reviewed, and the many processes that constitute transference are described. Two issues that have emerged in different guises for several decades-the role of the analyst in eliciting transference, and the nature of "real" and "transferential" components of the therapeutic relationship-are reconsidered in the light of concepts such as connectionist networks. Although a useful analytic stance is one that allows the patient's enduring dynamics to dominate the analytic field, it is suggested, anonymity is neither a cognitive possibility nor the driving force behind most transference reactions, and the distinction between "real" and "transferential" perceptions is one of therapeutic interest, not of mechanism. Certain features of the analytic situation make some dynamics more likely than others to enter the treatment relationship, notably those related to authority, intimacy and attachment, and sexuality. Transference reactions are best understood as constructed from a combination of the patient's enduring dispositions to react in particular ways under particular conditions; features of the analytic situation and of the analyst; and interactions between patient and analyst. These reactions do not unfold ineluctably from the patient's mind in the consulting room, nor are they cognitive constructions of the patient-analyst dyad or co-constructions of relatively equal partners exerting their influence on the analytic field.     

Accessing the transference relationship through previewing techniques

This paper proposes that in order to understand the etiology of the patient's conflict, the transference should be interpreted from a developmental perspective. The developmental approach examines processes derived from early life interaction. In particular, the paper focuses on aspects of the relationship between caregiver and infant that may be used analogously during analysis to evoke early life developmental phenomena. Developmental phenomena provide information about the caregiver-infant experience, as well as about the representational processes by which the individual has formulated models of the “self” and “other.” Understanding the interpersonal implications of these representational phenomena not only facilitates the interpretation of the transference, overcomes resistance and provides access to the conflict, but may also help the analyst promote more adaptive responses to future change.     

What's true and whose idea was it?

In this paper, the author explores the idea that psychoanalysis at its core involves an effort on the part of patient and analyst to articulate what is true to an emotional experience in a form that is utilizable by the analytic pair for purposes of psychological change. Building upon the work of Bion, what is true to human emotional experience is seen as independent of the analyst's formulation of it. In this sense, we, as psychoanalysts, are not inventors of emotional truths, but participant observers and scribes. And yet, in the very act of thinking and giving verbally symbolic 'shape' to what we intuit to be true to an emotional experience, we alter that truth. This understanding of what is true underlies the analytic conception of the therapeutic action of interpretation: in interpreting, the analyst verbally symbolizes what he feels is true to the patient's unconscious experience and, in so doing, alters what is true and contributes to the creation of a potentially new experience with which the analytic pair may do psychological work. These ideas are illustrated in a detailed discussion of an analytic session. The analyst makes use of his reverie experience-for which both and neither of the members of the analytic pair may claim authorship-in his effort to arrive at tentative understandings of what is true to the patient's unconscious emotional experience at several junctures in the session.     

Life-threatening illness in the analyst

The literature on practicing throughout a life-threatening illness is reviewed and important differences about attitudes toward self-disclosure are understood by noting a division between two perspectives on transference: "one-body" and "two-body" views. The analyst's use of self-disclosure is informed by the prominence given the interpretation of transference as against that given the patient's needs in the collaborative relatedness supporting the therapeutic alliance. Themes and illustrative clinical vignettes are presented from the author's own experience practicing during such an illness. Three phases of working during illness are delineated, each somewhat different regarding the analyst's state, and hence patients' needs and reactions. Recommendations are made regarding conditions that make it possible to work effectively during a life-threatening illness. The analyst needs help from his or her own analyst to make the clinically and sometimes ethically appropriate decisions about practice; while this is important in instances in which the analyst recovers, it is essential should the analyst become terminal and face more certain death.     

What does the analyst want? Free association in relation to the analyst’s activity, ambition, and technical innovation

The author traces the history of free association, the "fundamental rule," through the Freud-Ferenczi relationship and controversy. The use of "activity," first proposed by Freud in 1910 with phobic and compulsive patients, was then championed by Ferenczi in the early twenties. The goal of activity was to enhance-or, more accurately, "to force"--the associations into the analysis. Subsequently, Ferenczi reversed himself, concluding that his analysis was re-creating the traumatic parental environment which originally caused the patient's neurosis. The far-reaching results of Ferenczi's change of heart included a redefinition of countertransference and added the techniques of "indulgence" and "relaxation" to soften Freud's emphasis on "abstinence" and "frustration. A vignette from the analysis of a dangerously self-destructive bulimic patient illustrates the value of free association in helping a patient feel understood by the analyst without pressure to give up her symptoms. Constantly monitoring his therapeutic ambition, the analyst demonstrates the value of free association in enhancing the patient's understanding of herself and of the survival value of her symptoms. This vignette highlights the fact that the analyst's therapeutic ambition makes freedom to associate even more difficult for the patient and inevitably intrudes on the analyst's evenly hovering attention. Of course for the analyst to have a therapeutic wish is necessary and desirable but for the analyst to demand change promotes compliance and hidden rebellion which limits the analysis.     

How and why do patients become more objective? Sterba compared with Strachey.

What Richard Sterba described in his influential paper was not, as some have thought, a lasting alliance between patient and analyst but a momentary dissociative state, accompanying the analysis of transference resistance, in which the patient detaches himself from his strivings and views himself objectively before lapsing back into normal coherence. We also find in the paper a hinted answer to the vexing question of what motivates patients to engage in characteristically psychoanalytic self-scrutiny. Sterba implicitly proposes a problem-solving incentive activated by transference. A comparison with Strachey leads us to ask whether patients progress only by disinhibition of particular strivings through particular resolutions of particular fears, or whether patients also experience a more general liberation that fosters their own, deliberate search for integration.     

The patient's perception of the analyst: the hidden transference.

Just as the person of the analyst becomes a nidus for the manifestations of transference, so does the analyst's technique. When the patient misperceives person and technique, identifying the transference is not difficult. More complicated are those situations in which the patient's perception of the analyst and of his or her technique is congruent with the analyst's self-representation, or when the patient uses reality aspects of the analysis and the analyst as a resistance. Clinical material from the analysis of three patients is used to illustrate this.     

Pictures of treatment by Gill and Schafer

Roy Schafer and Merton Gill evoke two historically distinguished images of psychoanalytic treatment, one showing analysis elaborating life histories, and the other picturing the analyst as stirring transference embers into flame. A close examination of their implied theories of therapeutic action suggests that they mainly differ on whether allusions to the analyst are often localized in certain gestures or are always uniformly distributed throughout the patient's presentation. Because of this theoretical difference, these authors use different means to invite new experience, and they weigh differently the advantage of having a firm guide to turning-points in behavior against the advantage of maintaining an unconfinable curiosity.     

Identity maintenance in the affectively distant patient

Patients who are affectively distant, in that they appear to have little conscious emotional investment in the analyst, have been described increasingly in the psychoanalytic literature of the last twenty years. Typically, they have been understood either from a developmental point of view as defensively struggling against wishes for symbiotic union or, on the Kleinian model, as having unconscious fantasies of bodily fusion with the mother that, upon separation from her, result in annihilation anxiety that generates autistic defenses. Of special importance is the work of Heinz Lichtenstein, who stresses early identity maintenance and the role of mirroring experiences with the mother in the development of an "identity theme." This concept is used here as a symbiotic precursor of ego identity that ties the self to a particular mother. It is this primitive form of identity that can occasion regressive self-definition in the transference of the affectively distant patient. Two cases are presented that illustrate dynamics and transference dispositions occurring in the psychoanalysis of these patients. The discussion focuses on the role of the patient's catastrophic fear of acceptance, as well as on the consequent need for self-protective measures. It is argued that careful and consistent analysis of these conflicted areas of these patients' transference leads toward greater integration of their identity and personality.     

The centrality of the psychoanalytic setting and the changing aims of treatment. A perspective from a theory of object relations

The psychoanalytic setting, which includes the bond between analysand and analyst, is the foundation of psychoanalytic treatment. This object tie, although in the here and now, and "real", is demarcated from ordinary life and can be thought of as existing within a different level of reality. The psychoanalytic setting is subject to symbolic transformations that enable non-specific developmental conflicts to be worked through. I have described this transformation as the "dependent/containing transference," which I have compared and contrasted to the highly variegated and specific "iconic" transference (transference neurosis). This view of the psychoanalytic setting leads the analyst to pay special attention to problems of entrustment and safety and to the communicative process that regulates the closeness and distance between the two participants.     

Intersubjectivity and interaction in the analytic relationship: a mainstream view

The authors conceptualize intersubjectivity as a meta-theory that reflects the inherent nature of human relatedness and is conceptually independent of any particular theory of mind or school of psychoanalysis. Their view of intersubjectivity joins the emotional life of the analyst to that of the patient and places the analytic relationship at the center of the analytic process. They contrast intersubjectivity with traditional classical conflict theory so as to clarify the relevance of intersubjectivity for psychoanalytic clinical theory and therapeutic practice. In so doing, they hope to direct analysts more firmly toward the study of the unconscious dyadic contributions to the affective, inactive, and interactive dimensions of the analytic situation and their impact upon the patient's actions within and experience of the analytic relationship. To illustrate their thesis, two hours from an analysis are presented in detail.     

Deconstructing the manifest dream

A major part of the analyst's task is to discover the basis for the patient's misidentification of his present life situation with significant but threatening events of his earlier life, now repressed and inaccessible to conscious recall. Reconstructing the patient's history is a crucial step in this process of discovery, but the dynamic relation between the present and the past must be reconstructed as well. The structure of the manifest dream contains the key to this relation. The imagery of the dream is a composite of experimental materials drawn from important drive-related events of the present and the past. The complex formed by the manifest dream and the patient's associations provides the analyst with data about both of these distinct sets of drive-related experiences. As Freud's discussion of his M elusine dream illustrates, one associative thread can be traced to an experience that incorporates a conflicted current wish. Another thread will lead to an experience in which a repressed wish of childhood has been expressed. Where the two associative threads converge, in the composite imagery of the dream, the basis for the identification between the wishes of the present and the past will be exposed. An understanding of the structure of the manifest dream helps to clarify some of the important theoretical issues left unresolved in Freud's writings. These include: the function of the day residue and the mechanism through which it is formed, the relation of the screen memory to the associative process, and the differing roles of condensation and displacement in dream construction and free association. A simple procedure is described for enhancing the recovery of the significant childhood memories whose details have been incorporated into the composite imagery of the manifest dream.     

Purposive aspects of the erotic transference

This paper illustrates the erotic transference of a male patient towards his female analyst and the pressures and resistances within the transference and counter-transference to act out sexually. The patient's desire to act out sexually is seen both as a form of repetition compulsion within the transference and, in its purposive aspect, as an expression of the patient's need to find a loving breast and an empathic father. The patient's confused sexual identity is seen as a narcissistic defence against the experience of unbearable frustration in the pre-Oedipal stage. Through internalizing a new primal scene, the patient is able to separate from his past and to work through the Oedipus complex within the transference.     

不只是“谈话疗法”：精神分析治疗中的非言语维度

精神分析治疗在很长一段时间里被视为“谈话疗法”,其治愈机制是将潜意识的内容意识化,语言解释在其中发挥关键作用。自20世纪末开始,越来越多分析师强调非言语交流在治疗中的作用。非言语交流不仅能够为咨访双方提供更丰富的交流形式,还能通过互动中的“相遇时刻”,实现对患者过去经验的重组,改变其有缺陷的内隐关系知晓。非言语交流和语言交流能够在治疗中发挥互补作用,未来的精神分析心理学要继续加强对非言语领域的研究。     

不只是“谈话疗法”：精神分析治疗中的非言语维度

精神分析治疗在很长一段时间里被视为“谈话疗法”,其治愈机制是将潜意识的内容意识化,语言解释在其中发挥关键作用。自20世纪末开始,越来越多分析师强调非言语交流在治疗中的作用。非言语交流不仅能够为咨访双方提供更丰富的交流形式,还能通过互动中的“相遇时刻”,实现对患者过去经验的重组,改变其有缺陷的内隐关系知晓。非言语交流和语言交流能够在治疗中发挥互补作用,未来的精神分析心理学要继续加强对非言语领域的研究。     

Medication as object

People experience and treat medication as though it were a person: in other words, as an object. Among the many symbolic meanings attributed to medication, this sort of personification, or object representation, is a meaning that medication is uniquely positioned to contain and convey: imbued with intentionality and influence, medication moves beyond the sphere of static, iconic representation and enters the changeable, dynamic object world of action, aim, and agency. Unlike more generic or stereotypic meanings, object representations attributed to medication may reflect the patient's specific dynamics and object relations. These representations are many and mutable, and take on shifting and overlapping forms that evolve with the analytic process. Medication may represent a third person within the framework of an analytic treatment, expanding the analytic dyad into a triad and offering new transference paradigms to explore. The defensive displacement of transferential qualities and attitudes, or split-off parts thereof, from the analyst onto medication can serve as a powerful resistance to the awareness of the transference to the analyst. Clinical examples illustrate the utility and importance of the analysis of medication as object, for both patient and analyst, with particular attention to the transference.     

The role of the patient's remembered history and unconscious past in the evolution of Betty Joseph's 'Here and now' clinical technique (1959-1989)

The author historicizes one aspect of Betty Joseph's ongoing technical contributions in terms of its originating London kleinian context. Early on she drew upon both the patient's remembered history and unconscious past, linking these experiences in past-to-present transference interpretations in order to effect psychic change. In evolving the technique of 'here and now' analysis, Joseph came to emphasize a communicative definition of projective and introjective identification as well as the significance of enactments while marginalizing the use of part-object anatomical interpretative language. She gradually set aside directly linking the patient's past with the present, compelled now by making direct contact with her patients. She now tracked how difficult patients acted in and responded to interpretations from moment to moment. The author maintains that the explicit and implicit conceptual work of Wilfred Bion as well as Joseph's continuous group workshop for analysts led to an increased understanding of the patient's projective impact on the analyst's countertransference responses, and thereby increased the analyst's capacity with 'difficult to treat' narcissistic spectrum patients described by her colleague, Herbert Rosenfeld. In recent work, while Joseph continues to elucidate what patients recall about their early past, she formats her understanding in terms of a direct analysis of the structure of the patient's projected internal object relations in the transference. The analyst works with the patient's communications and enactments, with a greater emphasis on a more 'inside-to-outside' understanding of transference in contrast to the earlier 'past-to-present' work associated with both Freud and Klein. This investigation concludes with one example of Betty Joseph's significant impact on contemporary kleinian technique by taking up some of Michael Feldman's work. Now the analyst listens to the 'past presented,' the patient's projected internal world, as well as tracks how the patient hears and subtly mishears interpretations for defensive, equilibrium-maintaining purposes, as the analyst attempts to effect psychic change by widening the ego's perceiving functions.     

The analytic state of consciousness as a form of play and a foundational transference

The analytic state of consciousness is a particular regressive altered state in the patient characterized by an increased sensitivity and reactivity to impressions arising from both the inner world and the analyst, a heightened sense of dependence and vulnerability, a permeability of boundaries in regard to the analyst, and a shift toward functioning on the basis of omnipotent fantasy in the analytic relationship. These changes are accompanied by a feeling of realness of one's psychic reality, but without any true loss of reality testing. Based on an analysis of the structure of play, this state can itself be understood as a kind of play; it serves as a foundational transference underlying more specific transference manifestations; and it is central to the analytic process. Over time, in response to physical aspects of the analytic setting, its safety, the analyst's emotional accompaniment, and a generally restrained analytic stance (an issue I discuss in some detail), it emerges in a more developed form that promotes symbolization and ownership of aspects of self, greater emotional presence, and a deeper sense of meaning in one's experience. Additionally, the concept of the analytic state of consciousness provides a new look at the role of abstinence and frustration in analytic process.     

Flirting with virtual reality

Psychoanalysis encourages patients to experience a virtual reality of the psychoanalytic relationship, in which both image and wish can be experimented with. Originally, the patient's awareness was supposed to move back and forth between the virtual and the actual, in a flickering and uncertain fashion. That is uncomfortable, and analysts have often preferred the domain of virtuality or of actuality, or have denied the distinction altogether. Recent philosophical developments and doubts about transference neurosis and reconstruction further tempt analysts to relax the flickering uncertainty of virtual and actual. Patient and analyst may gain comfort but lose something in the process.