Tactics and empathy: Defences against projective identification

In this paper the author argues that interpretations made when the analyst has not done the emotional work of recognising and bearing what kind of object she has become in the patient's psychic reality will be experienced as empty tactics – even lies – rather than interpretations of integrity. However, interpreting from a position of bearing the truth of the patient's perception will be technically difficult and indicate turmoil as the analyst struggles to take in the patient's view of her. If the analyst avoids integrating her own picture of herself with the patient's picture (despite giving voice to the patient's picture) the split inside the analyst will be felt and intensify the patient's need to split. Vignettes demonstrate how the analyst, believing she is trying to understand, may become a projective‐identification‐refusing object and the issue of the analyst's disclosure of her countertransference is examined. Ultimately, the author argues, a capacity to receive and bear projective identification requires empathy with both patient and analyst‐as‐patient's object, engaged in a process about which both are ambivalent.     

Memory in dreams1

In this paper the author discusses a specific type of dreams encountered in her clinical experience, which in her view provide an opportunity of reconstructing the traumatic emotional events of the patient’s past. In 1900, Freud described a category of dreams – which he called ‘biographical dreams’– that reflect historical infantile experience without the typical defensive function. Many authors agree that some traumatic dreams perform a function of recovery and working through. Bion contributed to the amplification of dream theory by linking it to the theory of thought and emphasizing the element of communication in dreams as well as their defensive aspect. The central hypothesis of this paper is that the predominant aspect of such dreams is the communication of an experience which the dreamer has in the dream but does not understand. It is often possible to reconstruct, and to help the patient to comprehend and make sense of, the emotional truth of the patient’s internal world, which stems from past emotional experience with primary objects. The author includes some clinical examples and references to various psychoanalytic and neuroscientific conceptions of trauma and memory. She discusses a particular clinical approach to such dreams and how the analyst should listen to them.     

Finding unconscious phantasy in the session: Recognizing form

The concept of unconscious phantasy has played – and still does play – a central role in psychoanalytic thinking. The author discusses the various forms by which unconscious phantasies manifest themselves in the analytic session as they are lived out and enacted in the transference relationship. This paper also aims at expanding the kleinian theory of symbol formation by exploring the impact that emotional aspects connected to early “raw’, “pre‐symbolic’ phantasies have in the analysis and how their corporeal elements interlock with the signifying process. The author follows the expressive forms of primitive unconscious phantasies as they appear in a psychoanalytic session and proposes that the emotional effect that can be experienced in the communication between patient and analyst depends in great measure on “semiotic’ aspects linked to primitive phantasies that are felt and lived out in embodied ways. Rather than a move from unconscious phantasies that typify symbolic equations to those showing proper symbolization, these can coexist and simultaneously find their way to what is communicated to the analyst. As early phantasies bear an intimate connection to the body and to unprocessed emotions when they are projected into the analyst they can produce a powerful resonance, sometimes also experienced in a physical way and forming an integral part of the analyst's counter‐transference.     

The seventh servant: The implications of a truth drive in Bions theory of 'O'

Drawing upon Bion's published works on the subjects of truth, dreaming, alpha‐function and transformations in ‘O’, the author independently postulates that there exists a ‘truth instinctual drive’ that subserves a truth principle, the latter of which is associated with the reality principle. Further, he suggests, following Bion's postulation, that ‘alpha‐function’ and dreaming/phantasying constitute unconscious thinking processes and that they mediate the activity of this ‘truth drive’ (quest, pulsion), which the author hypothesizes constitutes another aspect of a larger entity that also includes the epistemophilic component drive. It purportedly seeks and transmits as well as includes what Bion (1965, pp. 147‐9) calls ‘O’, the ‘Absolute Truth, Ultimate Reality, O’ (also associated with infi nity, noumena or things‐in‐themselves, and ‘godhead’) (1970, p. 26). It is further hypothesized that the truth drive functions in collaboration with an ‘unconscious consciousness’ that is associated with the faculty of ‘attention’, which is also known as ‘intuition’. It is responsive to internal psychical reality and constitutes Bion's ‘seventh servant’. O, the ultimate landscape of psychoanalysis, has many dimensions, but the one that seems to interest Bion is that of the emotional experience of the analysand's and the analyst's ‘evolving O’ respectively (1970, p. 52) during the analytic session. The author thus hypothesizes that a sense of truth presents itself to the subject as a quest for truth which has the quality and force of an instinctual drive and constitutes the counterpart to the epistemophilic drive. This ‘truth quest’ or ‘drive’ is hypothesized to be the source of the generation of the emotional truth of one's ongoing experiences, both conscious and unconscious. It is proposed that emotions are beacons of truth in regard to the acceptance of reality. The concepts of an emotional truth drive and a truth principle would help us understand why analysands are able to accept analysts’ interpretations that favor the operation of the reality principle over the pleasure principle—because of what is postulated as their overriding adaptive need for truth. Ultimately, it would seem that Bion's legacy of truth aims at integrating fi nite man with infi nite man.     

The Reconstruction of Psychic Trauma

The author discusses the difficulties that arose in the analysis of a female patient suffering from a delusional disorder, where traditional criteria of suitability for psychoanalytic treatment were initially lacking and had to be established as part of the process. The transference-countertransference interaction came to a deadlock, understood by the analyst as due to the patient’s pathological dyadic relating. She was lacking in her capacity of reflective functioning, and there was no potential space to foster a fruitful therapeutic dialogue between analyst and patient. The analyst adopted a bystander perspective as a vantage point from which to comment on the patient’s narrative, whereby she succeeded in gradually altering the dysfunctional dyadic exchange into an interaction where a triadic perspective was introduced as a means to making possible meaningful communication between patient and analyst. Substantial changes were achieved with this procedure as a point of departure. The case study highlights aspects of dyadic versus triadic functioning of the analytic pair, and serves to illustrate theoretical points pertaining to the ongoing debate between professionals on how the basic structural elements of the analytic relationship should be conceptualised.     

Beyond transference,countertransference, the silences and the opinion1

The author examines several works of an intersubjectivist trend, as well as writings by Hanly, Cavell and Bion, defending many of the named psychoanalysts' viewpoints. These viewpoints are expressed in the search and the struggle for truth, recognizing, like Popper, that truth exists but that we cannot know with certainty whether and when we touch upon it, only that this endless effort merits a lifetime's work because it is the attempt at an encounter with ourselves‐the true encounter. The author explains the criticisms by Green of Jacobs, and defends the maintenance of ‘a certain possible neutrality’ (Eizirik). He poses some questions with regard to Ogden's ‘third subject’, considering it, among other aspects, from the supervisory point of view, which may demonstrate the existence of ‘a certain possible objectivity’ of the emotional confl ict. He develops some criticisms concerning silence as an interpretative action by Ogden, and summarizes two case histories. Both were unconsciously attempting to manipulate the analyst intensely‐one of them to get the analyst to intervene in his love life, and the other to interrupt acting out.     

On authenticity: the question of truth in construction and autobiography

Freud was occupied with the question of truth and its verification throughout his work. He looked to archaeology for an evidence model to support his ideas on reconstruction. He also referred to literature regarding truth in reconstruction, where he saw shifts between historical fact and invention, and detected such swings in his own case histories. In his late work Freud pondered over the impossibility of truth in reconstruction by juxtaposing truth with ‘probability’. Developments on the role of fantasy and myth in reconstruction and contemporary debates over objectivity have increasingly highlighted the question of ‘truth’ in psychoanalysis. I will argue that ‘authenticity’ is a helpful concept in furthering the discussion over truth in reconstruction. Authenticity denotes that which is genuine, trustworthy and emotionally accurate in a reconstruction, as observed within the immediacy of the analyst/patient interaction. As authenticity signifies genuineness in a contemporary context its origins are verifiable through the analyst’s own observations of the analytic process itself. Therefore, authenticity is about the likelihood and approximation of historical truth rather than its certainty. In that respect it links with Freud’s musings over ‘probability’. Developments on writing ‘truths’ in autobiography mirror those in reconstruction, and lend corroborative support from another source.     

On psychic elements in a case of autistoid perversion

The paper explores the formation of psychic elements from an epistemological point of view, drawing on the work of Bion to examine a clinical case of autistoid perversion. Distinguishing the qualification of psychic elements from the realization of pre‐conceptions, the paper argues that psychical elements are constituted through a mutually shared experience of presence, and so they should be understood in a paradoxical way – through being‐O and transformations into K. These ideas are explored via a clinical case concerning a patient with an autistoid–perverse organization. The patient had been denied any bodily contact with her parents during her first year of life due to an infection; in later life she exhibited an autistoid coprophilic perversion. During the course of her treatment, as it became possible to break down the autistoid organization, the nameless contents surfaced in a mutually shared experience of presence. The analyst was able to hold on to their meaning, which was unavailable to the patient. The absent analyst, however, turned into the mother who ‘put the child down’ and was experienced by the patient as a suicidal threat. In being‐O, the analyst was able to endure the paradox of being the one who ‘put her down’ in order not to put her down; the paradox of being‐O functioned as a container for the destructive objectal dimension of the state of ‘being put down’.     

Thinking Developmentally in Child and Adult Psychoanalysis

Psychoanalysis in theory and clinical practice is a developmental domain. Psychoanalysts think about their patients from a developmental point of view. The analytic relationship promotes development in both analyst and patient. Two concepts central to this author’s developmental point of view are epigenetics—as used in biology and philosophy—and that of the analyst as “developmental object.” Optimally, the analyst as developmental object facilitates what Rita Tähkä terms the “developmental illusion,” which intersubjectively transforms psychic structures, enabling alternatives to the repetition compulsion. Two vignettes with adult patients illustrate how empathic intimacy in psychoanalysis with an emphasis on latency and toddler phases as reconstructed in adult analysis presaged psychic growth. Transference as a vehicle for a developmental history taking is also considered.     

Transformations in dreaming and characters in the psychoanalytic field1,2

Having reviewed certain similarities and differences between the various psychoanalytic models (historical reconstruction/development of the container and of the mind's metabolic and transformational function; the significance to be attributed to dream‐type material; reality gradients of narrations; tolerability of truth/lies as polar opposites; and the form in which characters are understood in a psychoanalytic session), the author uses clinical material to demonstrate his conception of a session as a virtual reality in which the central operation is transformation in dreaming (de‐construction, de‐concretization, and re‐dreaming), accompanied in particular by the development of this attitude in both patient and analyst as an antidote to the operations of transformation in hallucinosis that bear witness to the failure of the functions of meaning generation. The theoretical roots of this model are traced in the concept of the field and its developments as a constantly expanding oneiric holographic field; in the developments of Bion's ideas (waking dream thought and its derivatives, and the patient as signaller of the movements of the field); and in the contributions of narratology (narrative transformations and the transformations of characters and screenplays). Stress is also laid on the transition from a psychoanalysis directed predominantly towards contents to a psychoanalysis that emphasizes the development of the instruments for dreaming, feeling, and thinking. An extensive case history and a session reported in its entirety are presented so as to convey a living impression of the ongoing process, in the consulting room, of the unsaturated co‐construction of an emotional reality in the throes of continuous transformation. The author also describes the technical implications of this model in terms of forms of interpretation, the countertransference, reveries, and, in particular, how the analyst listens to the patient's communications. The paper ends with an exploration of the concepts of grasping (in the sense of clinging to the known) and casting (in relation to what is as yet undefined but seeking representation and transformation) as a further oscillation of the minds of the analyst and the patient in addition to those familiar from classical psychoanalysis.     

Faith as the Fulcrum of Psychic Change: Metaphors of Transformation in Jewish Mysticism and Psychoanalysis

This paper examines the role of faith in transformation, proposing that faith, on the part of the patient as well as the analyst, is the turning point of psychic change. It uses the metaphors of transformation of the Jewish mystical tradition as an organizing framework with which to consider the transformational experience within psychoanalytic process and the evolving view within psychoanalysis of the relationship between analyst and analysand as one of asymmetry and mutuality. It posits faith as a mutual yet asymmetrical stance within the psychoanalytic relationship of intersubjective, mutual recognition. In faith, one opens to the possibility of the transcendent Third, an experience of union with a larger whole from which one emerges with a sharper sense of one's authentic truth.     

‘Translation’ and ‘transformation’ in the analytic situation: Freud – Bion – Laplanche

Following a short introduction to the core theses of Jean Laplanche’s theory of a ‘general seduction’ the author presents the resultant clinical position of the analyst. In the same way that an adult sends ‘enigmatic messages’ to the child, it is the analyst’s task to reopen this primal situation so that the patient can find new ‘translations’ for these messages. Laplanche distinguishes between the function of the analytic frame – which represents and supports attachment – and the ‘sexual’– which is the repressed and constitutes the unconscious. Only the focus on this unconscious facilitates the deconstruction of ‘incorrect’ translations. Accordingly, the analyst, says Laplanche, should not take part in construction – this is a self‐construction of the patient – but only in reconstruction. The author compares this clinical model with Freud’s notions and the ‘transformation processes’ through the alpha function as described by Bion. She illustrates Laplanche’s model and the interpretation strategy with case material.     

Clinical Implications for the Expressions of Self and Identity in Adolescent Psychotherapy: Case Studies of a Vampiress and a Gangster

Self and identity are examined as significant complementary processes in the psychoanalytic psychotherapy of two adolescent patients. The distinction between these processes is underscored as emergent from neuropsychological developmental changes while being expressed within a shared unconscious process. These cases examined how the analyst and patients fostered their co-constructed potential space for therapeutic transformation. Each patient had adopted compensatory identities in response to profound psychic conflict. The treatments explored the function of their identities as objectified processes to cope with psychic trauma while also addressing an essential respect for the subjectivity of self as a vehicle for psychological truth.     

The stranger1

This work concerns a nine‐year analytical experience with a patient who presented as a main feature an apparent inability to experience and express feelings. Right from the beginning the author was confronted with the question of the viability of analytical work, considering transference or emotional involvement in the absence of perceptible establishment of an affective link on the part of the patient. The patient never missed a session, was usually very punctual and presented very rich material, but the accounts of his life, everything he was saying, hearing and observing was manifestly deprived of any emotional meaning for the patient and consequently deprived of sense for the analyst. If, at the beginning, the question was how to communicate with the patient, after some time it became a problem of how to enable the patient to communicate with himself. Confi rming an observation by Bion that the patient is the best colleague the analyst can have, the way forward was indicated by the patient himself. This article is a theoretical exercise based on this clinical experience, using concepts developed by Bion, Ferro and Winnicott.     

Nothing but the truth: self-disclosure, self-revelation, and the persona of the analyst

The question of the analyst's self-disclosure and self-revelation inhabits every moment of every psychoanalytic treatment. All self-disclosures and revelations, however, are not equivalent, and differentiating among them allows us to define a construct that can be called the analytic persona. Analysts already rely on an unarticulated concept of an analytic persona that guides them, for instance, as they decide what constitutes appropriate boundaries. Clinical examples illustrate how self-disclosures and revelations from within and without the analytic persona feel different, for both patient and analyst. The analyst plays a specific role for each patient and is both purposefully and unconsciously different in this context than in other settings. To a great degree, the self is a relational phenomenon. Our ethics call for us to tell nothing but the truth and simultaneously for us not to tell the whole truth. The unarticulated working concept of an analytic persona that many analysts have refers to the self we step out of at the close of each session and the self we step into as the patient enters the room. Attitudes toward self-disclosure and self-revelation can be considered reflections of how we conceptualize this persona.     

Cutting the silence: initial,impulsive self-cutting in adolescence

The paper explores initial, impulsive self-cutting in adolescence and conceives of early cutting as having the most potential for a communicative function, as the adolescents themselves and those around them may be most shocked at their self-harm. The author also conceives of the symptom of early, initial cutting as an effort to ‘cut through’ an emotional and familial circumstance that has been silent, suggesting that cutting generally implies a failure in containment and symbolisation. Using Green’s (1975) discussion of the original word symbol as ‘an object cut in two, constituting a sign of recognition when those who carry it can assemble the two pieces’ (Dictionnaires Le Robert), the author demonstrates that cutting has the potential to elicit intense feelings in the analyst who can have (in Green’s terms) a homologous experience to that of the patient. This elaboration within the analyst’s feelings returns a part to the patient. The meeting of the two communications (the patient’s cutting and the elaboration in the analyst’s mind) can create a potential space between them. The paper uses clinical vignettes and extended clinical material from a 16-year-old girl to elucidate the relationship between cutting – an emotionally inarticulate state – and the development of communication, containment and symbolisation through homologous experiences in the analyst.     

The Colonized Mind: Gender,Trauma, and Mentalization

The question of how gender and trauma may impact one another is explored through detailed clinical material from the author’s work with a patient contemplating, and then beginning, a transition from female to male. The author explores what happens when a mind is colonized rather than mentalized. The term colonize is used to describe the unconscious use of a child’s mind to store unprocessed trauma from an earlier generation. The author describes destabilizing feelings of uncertainty, shame, and anxiety in both patient and analyst at various points in the treatment.     

NON-DISCURSIVE EXPRESSIVE ELEMENTS AND THEIR ROLE IN THE CONSTRUCTION OF MEANING IN THE ANALYTICAL SITUATION

The author discusses the role of non‐discursive expressive elements in the construction of the analytical situation, using three examples to illustrate the problems with which he is concerned. His claim is that the issue in question necessarily involves the subject of affects, and he proceeds to discuss the difficulties associated with this subject. In addition, he considers the contributions of Green and Imbasciati, and Kleinian developments of this theme, including also the contributions of Bion—in particular the latter's theories concerning thought, in which emotion comes to assume an essential place in the origin of thinking. The author resumes the discussion by taking up his clinical examples, using them to put forward the view that non‐discursive expressive elements may well play a decisive role in the construction of meaning in the analytical situation. He suggests also that the meaning of an emotional experience may be thought of as a construction contributed to by a number of symbolic forms which both interfere with and interact with the symbolic system of language. Following examination of his third example, the author reflects on ‘musicality’, a notion sometimes referred to informally in clinical data in connection with the ‘emotional climate’ of the session. He proposes that the complex problem of meaning in music be extended to cover the construction of meaning in the psychoanalytic setting, and in so doing returns to ideas put forward by Suzanne Langer. His underlying view here is that essential elements of the musical phenomenon and essential elements of particular forms of emotional life give rise to the same emotional matrices—perhaps to what Meltzer calls ‘musical deep grammar’. Finally, the author considers various symbolic forms that contribute to the particular configuration of analytical situations, suggesting that the mental condition of ‘free‐floating attention’ requires the broad availability to the analyst's mind of a multiplicity of symbolic forms, his conversion of these into new expressions of meaning, and the possibility of their verbal communication by him to the patient.     

Mock juror's perceptions of a child witness passing or failing a truth and lies discussion or promising to tell the truth

This study examined the effect of a child passing or failing the UK truth and lies discussion (TLD) compared with the Canadian promise to tell the truth on mock jurors' decisions regarding witness credibility and truthfulness and defendant guilt. Ninety-two participants read a vignette that described a child witnessing his father physically attacking his mother. The vignette was manipulated for witness age (age 4 years and age 8 years) and TLD performance/promise. Supporting the hypotheses, participants rated the witness's credibility and truthfulness significantly higher after a witness passed a TLD and after promising to tell the truth. The age of the child witness did not significantly affect jurors' decision making. The results are discussed in relation to arguments regarding the abolition of the UK's TLD in favour of introducing a promise to tell the truth.     

In-Between: Shapes of Subjectivities in the Analytic Situation

Starting from concepts that Winnicott developed and that are unexpectedly near to postmodern concepts, I attempt to map some features of the complex territory that lies between analyst and patient from the viewpoint of the relationship that exists between subjectivity and objectivity. In the first section, I give a personal reading of Winnicottian model, emphasizing the idea that the subject’s unconscious acts upon and transforms the object’s (thereby putting in motion further unconscious processes within the object). Then I highlight the presence, in the transference, of various levels of communication and of a paradoxical multidimensionality that upsets the traditional space-time categories and also upsets the analyst’s mental stance. In the third section, I present a new form of countertransference (pervasive), through which the patient’s unconscious creates a sensory environment of proto-emotions and atmospheres, of states and rhythms, that have permeated it and that, due to their intensity and nature, arrived there without symbolization. Finally, I attempt to demonstrate how the patient can undergo psychic change only if the analyst has, himself, inhabited an analogous process of transformation in response to the disturbances arising within the analytical relationship. The clinical-theoretical stance emerging from these reflections sees the relation to the other, to oneself, and to the world as made possible by subjective creation always taking place in the unconscious.