Psychoanalysis and Diplomacy: Part III. Potentials for and Obstacles Against Collaboration

Given the pervasive influence of Realpolitik over government and the study of international relations, and some inherent difficulties within the field of psychoanalysis, it is not surprising that political science and psychoanalysis remain distant cousins. Part III in this series on diplomacy and psychoanalysis discusses obstacles against collaboration between these two disciplines, but also points to areas where collaboration is possible and can be useful.     

The trial period and the creation of analytic patients

Just as there are many roads to Rome, the trial period may be considered one of many opening moves in psychotherapy or psychoanalysis. The responsive – and responsible – therapist must be many things to many patients, some of whom know nothing about the psychotherapeutic/analytic process. Freud advocated the trial period to help him take a “sounding” when he knew little about the patient and when the patient knew little about psychoanalysis. R.I.P.? This brief communication laments the apparent demise of this promising procedure and makes an effort at resurrection by describing the hitherto unmapped latent structure of the trial period. Even if there are fewer patients in psychoanalysis today, there may be a number of reasons to recommend a trial period, no matter what we name this period of optimistic uncertainty at the beginning of every treatment. Even if “consultation” is the term de jour, the psychoanalytic psychotherapist cannot escape certain role responsibilities at the beginning of every treatment, which has been made clear in the ethical principles of the American Psychoanalytic Association. What we will learn about the trial period should serve our understanding of what must also occur in the beginning of every psychotherapy or psychoanalysis. Conceptually, I propose that a trial analysis (1) will serve as a discriminative stimulus, signaling, to the patient, the unique nature of the analytic conversation; (2) will permit an in vivo assessment of the patient's suitability for psychoanalysis, and, more importantly, the fit between analyst and patient; (3) will provide anticipatory socialization for the unfamiliar and difficult roles of patient and therapist within the analytic process; (4) will offer true informed consent about the task facing therapist and patient; and (5) will facilitate an opportunity for therapeutic assessment, all of which will help the naive patient acquire the skills and lived experience to become an analytic patient. The trial period is the perfect host for all that must happen – and what we can do– to help naive patients become analytic patients.     

CLINICAL WINNICOTT: TRAVELING A REVOLUTIONARY ROAD

The author contends that, contrary to the usual perception that Winnicott followed a linear progression “through pediatrics to psychoanalysis,” Winnicott's vision was always a psychoanalytic one, even during his early pediatric work. His place in the development of psychoanalytic theory is highlighted, and the author discusses such key Winnicottian concepts as transitional space, the false self, and the use of the object. Winnicott's unique approach to the form and value of analytic interpretation is particularly emphasized, and his thoughts on the treatment of depression are also addressed, as well as his distinction between regression and withdrawal. Included is a summary of convergences and divergences between Winnicott's thinking and that of Bion.     

SPONTANEOUS “CURES”: NORMAN REIDER'S FORGOTTEN PAPER,PART II

Part I of this paper combined an introduction to Norman Reider's original 1955 paper with a republication of the paper itself. Part II is a discussion of the complexities of a comparison of past and present psychoanalytic literature. The concept of enactment is proposed as one of many possible alternative views in considering Reider's notion of spontaneous “cures.” A careful consideration of these spontaneous cures within the ordinary ups and downs of any psychoanalytic treatment sheds important light on our continuing confusion about how we define the term cure, and therefore about the nature of change during psychoanalytic treatment. This alternative perspective is only one of many plausible ones for present‐day readers. The purpose of this republication is not to propose an explanation for “what really happened” with Reider and his patients; rather, it is to reconsider the fallacy of evaluating his paper outside its historical context and thereby failing to appreciate his courage in presenting what at the time were radical views. Questions about the complexity and confusion regarding cure and change require reexamination of the neglect of epistemology on the part of psychoanalysis in prolonging the confusion about distinguishing psychotherapy and psychoanalysis.     

Comments on the Ikonen and Rechardt papers on the death drive and the origin of shame

In this paper, psychoanalysis is viewed as a method in opposition to the reigning spirit of our age with its demands for fast and measurable results. The concept ?the psychoanalytic room” is introduced in order to grasp the uniqueness of psychoanalysis and how it distinguishes itself from what is ordinarily held to be included under the category of work. The psychoanalytic room is explored in both a concrete and metaphoric sense and is discussed in relation to the concept of time, reality, Ogden's concept of the analytic third, and, inspired by Winnicott, children's play. The playroom of the child and its similarity with the analytic room is illustrated by the book ?Benny's Bathtub” by the Danish author Flemming Kvist Møller.     

On ethical issues at the foundation of the debate over the goals of psychoanalysis

In this paper the author points to ethical issues that underlie the debate over the nature of the goals of psychoanalysis. While it has been suggested that the lack of consensus and clarity in this debate may be partially explained in terms of opposing attitudes to the importance of therapeutic benefit and variance in core values of analysts and patients, the author shows that these explanations do not fully resolve the ambiguity. The examination of the limitations of the existing explanations points to the value of introducing an ethical dimension. She discusses two ethical issues: the complex nature of the ethical value of self-determination in psychoanalysis, and the ethical status of analytic change. The clarification of these two issues contributes to an understanding both of the inherently controversial nature of the debate over analytic goals, and of the place of ethical considerations in psychoanalytic theory and practice.     

THE VALUE OF UNCERTAINTY

The author discusses some of the characteristics of Roy Schafer's contributions to psychoanalysis that he finds most valuable, such as his openness to uncertainty, his anti‐reductive view of analytic constructions, his unique formulation of the analyst's role, and his close attention to how the patient engenders particular emotional reactions in the analyst. The author also presents a clinical vignette illustrating the value of the analyst's tolerance of uncertainty in the face of the patient's push for interpretations, explanations, and reassurance.     

Grasping psychoanalysts’ practice in its own merits1

The central objective of this presentation is to reflect on the obstacles involved in the task proposed by the Chicago Congress, which is to explore convergences and divergences in psychoanalytic practice. The author discusses two major obstacles. First, the epistemological and methodological problems in relation to the construction of theory in psychoanalysis and especially the inaccessibility, in any reliable way, of what psychoanalysts really do in the intimacy of their practice. He proposes to separate, at least in part, theory from practice in psychoanalysis, in an attempt to grasp psychoanalysts' practice in its own merits. He then outlines a phenomenology of the practice of psychoanalysis, which reveals that, in their work with patients, analysts are guided more by practical reasons than theoretical reasons; that is, their interventions are predictions rather than explanations. Since these practical reasons need to be validated constantly in the analytic relationship based on their effects, he discusses the subject of validation in the clinical context of the core theory of therapeutic change in psychoanalysis, that is, the conditions required for clinical practice to satisfy the thesis of an inseparable union between gaining knowledge and cure. He ends by challenging the core of the psychoanalytic theory of change, arguing that it neither does justice to the practice of psychoanalysts nor to contemporary knowledge of processes and mechanisms of therapeutic change. Finally, he proposes that we detach practice from theory, in order to study the former in its own merits, utilising a plurality of methods ranging from systematic investigation to the recent methodology of the Working Party.     

ON THE THERAPIST'S YEARNING FOR INTIMACY

From the beginning of clinical psychoanalysis, analysts have been at risk of succumbing to yearnings for intimacy and contact that are stirred up by the heat of the analytic encounter. Recently, as theoretical developments have encouraged us to create moments of meeting (Stern et al. 1998) and have urged us to tolerate the feelings stimulated by enactments, these risks have increased. The author points out that foregoing the realization of this yearning within the analytic relationship and the resultant mourning for the loss of a fantasy or illusion carries a heavy personal price tag for the therapist.     

“This beastly science…”: On the reception of psychoanalysis by the composers of the Second Viennese School, 1908–1923

This paper explores the links between psychoanalysis and music in Vienna between the years 1908 and 1923, focusing in particular on two members of the highly influential Second Viennese School, the composers Alban Berg and Anton Webern. While there is little evidence of an actual interaction between Freud and his circle and contemporaneous musicians in Vienna, this paper discusses the direct personal and professional contact Webern and Berg had with Freud, and also with Freud's one-time colleague Alfred Adler; Berg's wife Helene also underwent psychoanalytic treatment. Both composers documented their experiences with and feelings about psychoanalysis, offering critical insights into the reception of psychoanalysis in musical circles in Vienna, and into the actual connections between psychoanalysis and Vienna's most important musical figures. This paper examines Berg and Webern in the context of Freud's Vienna, Adler's musical background and his treatment of Webern, and Berg's knowledge of psychoanalysis and strong ambivalence towards his wife's psychoanalytic treatment, and concludes by considering Berg's opera Wozzeck (1925) as an example of a musical work influenced by contemporary Viennese attitudes towards psychoanalysis.     

ROY SCHAFER'S CONTRIBUTIONS TO PSYCHOLOGICAL TESTING: FROM CLINICAL SENSIBILITY TO THE ANALYTIC ATTITUDE

The author reviews Schafer's contributions to psychological testing, emphasizing his development of the test battery, his significant contributions to psychoanalytically oriented Rorschach interpretation, and his understanding of the complex interpersonal dynamics involved in psychological test interpretation. The author also discusses his use of Schafer's writing in his own teaching and academic work, noting that Schafer's contributions have not only provided innovative methods for examining test data, but have also promoted a respectful, humanistic, and individualized approach to the patient in testing and treatment. The author asserts that Schafer's later seminal contributions to psychoanalysis had their origins in his early career as a psychologist applying psychoanalytic ideas to testing.     

BECOMING RELATED: THE EDUCATION OF A PSYCHOANALYST

The author uses a “professional memoir,” a story about his first experiences in clinical work, to illustrate what he believes to be certain fundamental aspects of an analytic attitude. Taking place in a psychiatric hospital, it is meant to highlight the central place of intuition, emotional receptivity, empathy, relatedness—and their inherent dangers—in engaging therapeutically with patients' emotional disturbances. The author postulates that these and related aspects of clinical psychoanalysis are not sufficiently emphasized in psychoanalytic training and are often eclipsed by idealizations of psychoanalytic theories and their derivative techniques, third‐party demands for evidence‐based data, preoccupations with neurobiological correlates of experience, etc. Despite the clinical fact that psychoanalysis can be extraordinarily helpful to patients, he questions whether clinical psychoanalysis is rightly regarded as a “treatment.”     

Anna Freud: The Hampstead War Nurseries and the role of the direct observation of children for psychoanalysis

The psychoanalytic tradition of direct observation of children has a long history, going back to the early 20th century, when psychoanalysis and the emerging field of 'child studies' came into fruitful contact in Freud's Vienna. As a leading figure in the attempted integration of direct observation with the new psychoanalytic knowledge emerging from the consulting room, Anna Freud played a crucial role in the emergence of this field. But her major contribution to the theory and practice of observing children came during the Second World War, when she founded the Hampstead War Nurseries. The author describes in detail this important period of Anna Freud's career, and discusses the impact it had on later work. He explores the theoretical contribution that Anna Freud made in the post-war years to the debate about the place of direct observation in psychoanalysis, and concludes that Anna Freud's 'double approach' (direct observation plus analytic reconstruction) still has a great deal to offer as a method of both psychoanalytic research and education.     

Editorial

Abstract

This paper will examine the current crisis in psychoanalysis in terms of the profession's decline, the apparent lack of patients, the ongoing debate over what constitutes psychoanalysis versus other therapies, and the lack of clinical focus in those debates. The concept of analytic contact will be introduced, and clinical material is used to showcase this concept as a bridge from the circular political debates to a more meaningful examination of what is psychoanalytic. In addition, case material will explore how patients tend to fight off the establishment of analytic contact in favor of safer, less threatening modes of relating. The author suggests that most patients fight off analytic contact and try to shift the treatment into something less analytic. It is up to the analyst to detect this, interpret it, and notice any countertransference collusion that may occur. Although the state of psychoanalysis as a profession is less than stellar in the eyes of the public, and the profession is apt to sabotage itself with endless debates about what constitutes true analytic work, the end is not necessary near. This paper proposes analytic contact to be the more useful focus of research and productive area of clinical exploration. If the decline of our field is to turn around, it will be on the clinical battlefront, not in terms of the theorizing among disagreeing groups of territorial analysts afraid of losing their political high-ground. The concept of analytic contact assumes that a deep exploration of intrapsychic phenomena, conflicts, and defenses, all within the realm of the transference, is the best clinical method of helping the mentally troubled individual. This genuine chance of change is best administered by a trained psychoanalyst. This simple idea is something the profession has contaminated with its often pointless arguments over frequency, analyzability, couch, and so forth. The clinical material will show that what happens in the room between analyst and patient is what best defines the true psychoanalytic treatment.     

BION'S “EVIDENCE” AND HIS THEORETICAL STYLE

The author discusses “Evidence” (1976), a brief but very intense and fascinating paper in which Bion provides a unique opportunity to see him at work in his clinical practice. In the story of a patient, Bion reconstructs two sessions that are all the more true for being imaginary—i.e., narrated (“dreamed”). The matter of language and style in psychoanalysis is of the utmost importance, according to Bion—one could say, literally, a matter of life or death. In Bion's discourse, writing, reading, and analysis converge in the same place, the author notes; all are significant if they involve an experience of truth and the ability to learn from experience.     

When Worlds Collide: Psychoanalysis and the Empirically Supported Treatment Movement

In this conclusion, I synthesize and elaborate on some of the central threads running through the contributions to the symposium on the implications of the empirically supported treatment (EST) controversy for psychoanalysis. I argue that the EST controversy brings increased urgency to discussions about the role that empirical research should play in the development of psychoanalysis and about the potential contributions of different research paradigms to the field. Different research paradigms are associated with different epistemologies and worldviews, and the dialogue between these worldviews is critical to the vitality and health of the field. On one hand, the EST movement embodies limited, mechanistic, and one-sided values, and psychoanalysis has an important role to play in challenging these values. On the other hand, the EST movement can offer an important corrective to the more insular and rarefied strands within psychoanalysis and to its tradition of argument on the basis of authority.     

The Silence of the Body

As a practice meant to release the subject from the narcissism that informs the concerns and preoccupations of her or his ego, psychoanalysis aims at a transformation of the subject comparable to the Buddha's quest for enlightenment. In order to clarify this subtle and difficult dimension of psychoanalytic work, this essay draws upon a clinical example and discusses it in the context of both Freud's and Lacan's ideas about the role of narcissism in the formation of the ego, and the Buddha's doctrine of Anatta, which insists that the concept of the Atman, or self, is based upon an illusory thought.     

On presence in the psychoanalytic relation

This paper discusses presence in the psychoanalytic relation, the analysand’s and the analyst’s. Clinical situations with different qualities of presence will be considered focusing on what kind of interplay between analysand and analyst they may lead to. As examples, I have chosen three different clinical situations: In the first there is an interplay between the analysand’s free associations and the analyst’s ‘evenly suspended attention’. In connection with this I will discuss Bion’s concepts of ‘reverie’ and of ‘O’. In the second there is where the interaction is characterised by what Meltzer calls ‘geographical confusion’. In the third there is a ‘transference delusion’ in the psychoanalysis of breakdown as Winnicott describes it.     

Reaching out for the object in the process of meeting

Reaching out for an object has been broadly discussed within psychoanalysis using the term 'object-seeking'. This article develops the idea that it is a fundamental feature of human beings to reach out for objects in order to survive and/or to gain vitality. Self-love, which is a derivative of object love, is not possible to achieve in a developmental manner without a sufficient phase-specific emotional response to the subject’s object seeking. In terms of psychoanalytic methodology, the present article represents a tradition (e.g. Tähkä) of renewal related to the classique approach, which is a more passive psychoanalytic technique (e.g. Freud and Winnicott). This traditional psychoanalytic methodology is complemented with a more active technique in order to be therapeutically efficient – especially in the treatment of individuals who are not primary neurotic. The four psychoanalytic schools (drive, object relations, ego and self-psychology) are integrated in a patient’s authentic attempt to reach out for the developmental object in the process of meeting.     

Authority as paradox: The transformations of Don Quijote

The author's contention is that the analysand's temporary attribution of authority to the analyst is inherent in the analytic situation; this is seen as a transitional and paradoxical form of authority pertaining neither to internal nor external reality, but dwelling in the analytic third. The author proposes a conceptualization of psychoanalytic authority as a form of aesthetic authority according to Gadamer's defi nitions. While the scientifi c and hermeneutic codes for the understanding of authority in psychoanalysis assume that the main issue at stake is the delimitation of the objectivity or the subjectivity of the analyst's knowledge, this aesthetic perspective centres on the analysand's attribution of a claim of truth to analytic interpretations, and on the experience of recognition. The experience of recognition of a possible truth is particular and context-bound, as well as self-transformational. A reading of three episodes from Cervantes's The history of Don Quixote de la Mancha illuminates the transitional and paradoxical character of aesthetic authority within a transformational dialogue. These episodes are read as dramatizations of different positions vis-à-vis the paradoxical authority that characterizes transformational dialogues.