The dynamics of interpretation

The patient's productions are a dynamic record of the conflicts of the past as they are recapitulated and re-experienced in the present. Much can be learned by closely studying the immediate effect of the analyst's interventions. Interpretation, especially of transference phenomena, will upset the equilibrium which has been effected and will enable the patient to understand how unconscious fantasies from the past continue to influence his perception and reactions in the present. Interpretation is a continuing process, unfolding in logical sequence. Transference may be an expression of the patient's resistance to recognizing an unconscious wish toward the original object.     

Preconscious defence analysis, memory and structural change

Beginning with the ways in which the use of the couch lends 'depth to the surface' (Erikson, 1954), I explore the topography of the inter - and intra subjective psychoanalytic situation and process. I suggest that defences are not by definition unconscious but rather can be observed operating at conscious and preconscious levels, particularly under these conditions. A focus on preconscious disavowal provides a window on what has become unconscious repression. As a result of eliciting and then verbalising the operation of such defences with regard to anxieties in the here-and-now transference, declarative memories of increasingly specific childhood fantasies and events begin to hold sway over unmanageable procedural remnants from the analysand's past. With this may even come the possibility of neuronal regeneration, the more generalisable enhancement of declarative and symbolic functions and the sense of identity with which these are associated. Herein may lie one enduring therapeutic effect of the 'talking cure' - putting feelings into words - as one among a variety of psychotherapeutic modalities.     

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 analytic process in psychoanalysis and psychotherapy: from the interpersonal to the intrapsychic level

The current debate over the conflicting interpersonal and intrapsychic views of the analytic process may or may not help us to distinguish between psychoanalysis and analytic psychotherapy. A comparison of psychoanalysis in the English-speaking world--especially in the United States--with French psychoanalysis reveals the features that unite and at the same time divide these different psychoanalytical tendencies, both of which are the heirs to Freud's thought, in terms, in particular, of the setting (couch and chair) and of technique (interpretation, transference analysis and technical neutrality). Whereas all psychoanalytic work belongs within the framework of an interpersonal relationship, that relationship becomes meaningful only when linked to the intrapsychic dimension, which alone can open the way to the unconscious and to infantile sexuality.     

MAPPING THE LANDSCAPE: LEVELS OF TRANSFERENCE INTERPRETATION3

The author argues that there are distinctly different kinds of transference interpretation, each of which might be valid in particular circumstances in analysis, but which contain and imply different understandings of what is meant by a ‘transference interpretation’. She suggests that transference interpretations may be at any one of four different levels, and she describes these levels as ranging from interpretations that point to links between current events in the analysis and events from the patient's history, through interpretations that link events in the patient's external life to the patient's often unconscious phantasies about the analyst and the analysis, to interpretations that focus on the use of the analyst and the analytic situation to enact unconscious phantasy configurations, sometimes pulling the analyst into the enactment. Material from four consecutive sessions of an analysis is presented to illustrate how all levels of transference interpretation may be part of a lively and meaningful analysis, but how the level of interpretation may change as the level of understanding deepens within a session and from one session to the next.     

TRANSFERENCE BEFORE TRANSFERENCE

This paper is predominantly a clinical presentation that describes the transmigration of one patient's transference to another, with the analyst functioning as a sort of transponder. It involves an apparently accidental episode in which there was an unconscious intersection between two patients. The author's aim is to show how transference from one case may affect transference in another, a phenomenon the author calls transference before transference. The author believes that this idea may serve as a tool for understanding the unconscious work that takes place in the clinical situation. In a clinical example, the analyst finds himself caught up in an enactment involving two patients in which he becomes the medium of what happens in session.     

A significant "dream within a dream"

This brief clinical note is an attempt to clarify Freud's remarks regarding the significance of real occurrences of the "dream within a dream". There is affirmation of the reality of an actual event in the manifest dream (the "tickling" in adolescence). Certain representations regarding real events are alluded to in the manifest dream and are confirmed by the latent dream thoughts (the underlying homosexual theme involving the patient's mother and herself). Within the ongoing transference neurosis, a new understanding led this patient to experience intense sexual affects which were recalled for the first time during the course of an analytic session. The analyst's attention to this "dream within a dream" led to a facilitating active interpretation of the repressed sexual feelings. At the same time it was possible to observe a developmental arrest which had interfered with the consolidation of the patient's adolescent maturation begin to be undone by interpretation. The process of disengaging the patient from her unconscious bond with her mother (the undoing of the negative oedipal involvement) had been set in motion. The "dream within a dream" seems to represent a special defensive effort of the dream work to encapsulate the memory of one or more related actual events and the intense affects associated with them--affects whose pressure for discharge threaten to arouse the sleeper. The form the dream assumes is related to its hidden sexual origins and engages the active participation of both patient and analyst.     

The real person of the analyst and his role in the process of psychoanalytic cure

This paper focuses on the real relationship with the analyst in the psychoanalytic situation as an aspect of the therapeutic process that leads to change. The role of free association, clarification, and interpretation of the transference are taken for granted as major activities of the analyst, and the real relationship with him is seen as a complementary but important ingredient for change. In particular, his emotional availability determines the climate of analysis. The concepts of neutrality, anonymity, and abstinence, though of importance as guideposts in the conduct of an analysis, have conceptual limitations that not infrequently bind the analyst in a stance that is not useful for the progress of the analysis. On occasion, confirmation by the analyst of the verity of an experience in the patient's early life facilitates the analytic process. This occurs particularly in situations of early trauma, but at times may include chronically traumatic early life experiences. An important motivating force in analysis is the patient's unconscious wish to find the ideal parent absent in early life experience, a wish that is experienced and ultimately analyzed. This is to be distinguished from a defensive idealized transference. Psychoanalytic developmental psychology contributes to our understanding of how the real person of the analyst, his emotional availability, his responsiveness at particular times, his attitude toward action and progressive change in the patient, affect the therapeutic process that leads to change.     

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 unconscious transference effect: Are innocent bystanders ever misidentified?

Unconscious transference refers to an eyewitness's misidentification of an innocent bystander for a criminal perpetrator because of the witness's exposure to the bystander in another context. In a series of five field studies involving 330 retail store clerks and 340 students, five retention intervals from 2 hours to 2 weeks, seven bystander-perpetrator intervals from 2 minutes to 2 weeks, three line-up types, two levels of line-up similarity, four different bystanders and four different targets, with one exception no evidence was obtained that could be interpreted to demonstrate the phenomenon of unconscious transference. That is, the resultsr repeatedly failed to reveal more misidentifications of an innocent bystander by witnesses who had been previously exposed to the bystander than by control evewitnesses who had not. To the contrary, the prior observation of the bystander often served to reduce the frequency of misidentification. In the final experiment the kind of misidentification error referred to as unconscious transference did occur, but only within a particular combination of bystander-perpetrator similarity and line-up construction: a combination that, in conjunction with the kind of event used, seems unlikely in real-world settings. Nevertheless, the inclusion of a familiar face in the line-ups often altered witnesses' choices in such a way that choosing someone was more likely when the lineup included a familiar face than when it did not. Finally, in contrast to the current explanations of unconscious transference, it is argued that it may not be a sense of familiarity with the bystander that is the basis of misidentifications; rather, it may also include incorrect inferences about the likelihood that the bystander might be the perpetrator.     

In the last analysis: archetypal themes in the analysis of an elderly patient with early disintegrative trauma

Aspects of the analysis of an elderly patient with early disintegrative experiences are described: separation anxiety, an internalized attack upon vitality, and the fear of dependency were prominent features of the transference/countertransference relationship, while the search for meaning as death drew nearer continued to be the central theme. The patient's many dreams reveal a wealth of images whose complex interlinkings provided evidence of a heightened and energized individuation process aiming at the integrity of personality.     

On patients' disclosure of parents' and siblings' names during treatment

The patient's spontaneous disclosure of a parent's name is frequently associated with appearance of core conflicts, especially genetic and transference themes of incest, other oedipal derivatives, and separation anxiety. Using a parent's first name has the unconscious implication of incest, since one is doing something which one's other parent but not oneself is allowed to do. In some primitive cultures, saying aloud the names of one's parents was strictly forbidden. Disclosing a parent's name to the analyst may parallel the developmental step during childhood when the patient learned the parent had a first name. The child's acquisition of language, including proper names, fosters object constancy and the internalization of the parents, from whom language is learned. For patients who do not usually refer to a sibling by name, disclosure of the sibling's name may also reflect the concurrent emergence of central conflicts. In particular, such disclosure may accompany associations about an earlier closeness with the sibling giving way to subsequent estrangement. Naming the sibling may also mark an intensification of a sibling transference to the analyst.     

The week the couch arrived

Changes in the therapeutic environment can elicit intense and unpredictable responses from patients, who then react to the new elements with their own unique thoughts, fantasies, emotions and behaviours. When the change is very specific, and when it entails implications for the treatment itself, these patient responses can coalesce around more profound experiences of the transference as well as of the countertransference. The author, as a candidate or analyst-in-training, purchased an analytic couch for his office and observed the unfolding of what this new couch meant for existing treatments. Using clinical examples, he describes the three most common patient responses that occurred: rejecting, ambivalent, and embracing. The richly variant ideas and fantasies related to the analytic couch are described, and the couch's history within Freudian and Jungian contexts is reviewed. Personal determinants that could lead to the decision of whether to use a couch as part of analysis are considered from the standpoint of the analyst's preferences and own experience with the couch. The couch is discussed as a signifier of the analytic process with cultural meanings alluding not only to familiar stereotypes, but also to psychological healing and self-development.     

Repression, transference and reconstruction

Whereas Peter Fonagy almost dismisses the importance of repression and the recovery of repressed and suppressed memory, the author believes that the analysis of repression retains importance in clinical psychoanalysis. Transference is a return of the repressed, with repressed memories embedded within a fundamental unconscious fantasy constellation. Moreover, transference is an essential, but not the only, route to the understanding and analysis of the patient. Nor should transference be confused with the real or new analytic relationship. The author does not regard the dynamic unconscious as definitely registered and retrieved in procedural memory, awaiting further research. A focus on the present 'self with other' model of therapeutic action neglects pathogenesis and the importance of childhood and its psychoanalytic reconstruction.     

2. Freud's 'id' and Jung's 'self' as aids in self-analysis

The id and the self are described as constructs of our unconscious which can be deployed in describing the analytic process. They can be used like the x in mathematics or the joker in a pack of cards as fitting in almost anywhere. But we can call on them as important aids to concentration, when additional room is made for meditating on the past which then comes to life again. They are useful for analysing ourselves and others. In this way the id as well as the self become aide-mémoires. The analysis of the repressed by means of the transference is not the only road to hitherto unconscious memories. This kind of meditation has helped me despite all reservations to undertake self-analysis and to write an autobiography. I maintain that one can have a transference to oneself. It is, of course, narcissistic. But then, no one can write an autobiography without a healthy dose of narcissism.     

Daimonic elements in early trauma

This paper explores some of the 'daimonic' elements of unconscious mentation that emerge both in dreams and in the transference/countertransference field with early-trauma patients and illustrates these with an extended clinical example. An archaic and typical (archetypal) 'trauma complex' is articulated (with diagram) as a bi-polar structure consisting of divine child protected and/or persecuted by an inner 'guardian angel'. Sources of this structure and its mythological inner objects are traced to trauma at the stage of what Winnicott calls 'unintegration' and to flooding by disintegration anxiety at a time before nascent ego-structure has formed. In an extended case example, the author shows how the patient's traumatized innocence and desire for a new start, thwarted by self-attacking defences, pulls him into playing the inflated role of her guardian angel, leading to re-traumatization in the transference. Working through is seen as the necessary disillusionment and humanization of these daimonic structures as they are projected, suffered, and transmuted by the analytic partners in the stormy process of psychotherapy.     

Psychoanalytic identity and the external world: Interaction between psychoanalysis and health service systems in Sweden

Abstract

This paper continues the exploration of the clinical phenomenon of analytic contact. The author demonstrates, through case material, the essential ingredients of psychoanalysis to be not frequency or use of the couch, but rather the moment-to-moment analysis of the patient's transference state and phantasies of what it means to establish relational contact with their objects and with themselves. The nature of the treatment can be shaped, prevented, perverted, or fostered by the patient's phantasies and unconscious conflicts into something more analytic or less analytic. Interpretation needs to include the exploration of the patient's attempts to change the treatment into something that is often a replica or a repetition of archaic object relations. The typical patient in psychoanalytic treatment is struggling with rather profound pathology and as such tends to create a significant stand-off with the analyst when analytic contact is forming. Analytic contact is often threatening to these patients in very primitive and alarming ways that must be gradually understood and interpreted if the treatment is to survive and remain a primarily analytic journey rather than be transformed into a more supportive counseling or a pathological re-enactment of conflictual phantasy states.     

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.     

Adult age differences in unconscious transference: Source confusion or identity blending?

Eyewitnesses are known often to falsely identify a familiar but innocent bystander when asked to pick out a perpetrator from a lineup. Such unconscious transference errors have been attributed to either identity confusions at encoding or source retrieval errors. Three experiments contrasted younger and older adults in their susceptibility to such misidentifications. Participants saw photographs of perpetrators, then a series of mug shots of innocent bystanders. A week later, they saw lineups containing bystanders (and others containing perpetrators in Experiment 3) and were asked whether any of the perpetrators were present. When younger faces were used as stimuli (Experiments 1 and 3), older adults showed higher rates of transference errors. When older faces were used as stimuli (Experiments 2 and 3), no such age effects in rates of unconscious transference were apparent. In addition, older adults in Experiment 3 showed an own-age bias effect for correct identification of targets. Unconscious transference errors were found to be due to both source retrieval errors and identity confusions, but age-related increases were found only in the latter.