A DISCOURSE ON SOPHOCLES: FREUD AND DETERMINISM

A study on the subjective experience of neuroleptic treatment is used as an example of research that employs psychoanalytic theory and methodology outside the clinical situation. Psychoanalytic tenets such as psychosexuality and the unconscious are highlighted, and the systematic study of internal reality is discussed with reference to the study on neuroleptics, the results of which are presented in extenso. Metapsychology is considered as a means for systematization, and self-reflexive countertransference analysis is seen as a means for fostering trustworthiness and reliability. The validity criteria discussed are clinical relevance, coherence, and originality (as distinct from merely confirming received theory). Value conflicts between academic and psychoanalytic scientific cultures are described with reference to the data of the specimen study. The concluding discussion includes a brief comparison of the time-limited interview method with long-term, clinical psychoanalytic inquiries.

“Flechsig's Brain science is the theory and Schreber's delusions are the practice of the same traumatic collapse of…subjectivity, of the gap separating bodily cause and symbolic effect. Schreber's point would seem to be that the elimination of the gap—the attempt to fill it with neuroanatomical knowledge—is nothing short of soul murder.” Eric Santner (1996), My own private Germany: Daniel Paul Schreber's secret history of modernity (p. 75)     

Even More Than the “Something More”: Tronick’s Dyadic Expansion of Consciousness Model and the Expansion of Child Psychoanalytic Technique

Contemporary psychoanalysis considers itself to be a discipline fundamentally concerned with meaning and meaning-making processes. Ed Tronick’s research provides scientific support for the theoretical position that meaning making is a central process in psychological development and in mental health/illness. His work collaborating with psychoanalysts has made major contributions to the psychoanalytic literature on therapeutic action, with a special emphasis on the means by which implicit meanings are activated and modified in analytic treatment—the something more than interpretation. This article is about a different something more, the even more that psychoanalytic theory and technique can evolve through further incorporating Tronick’s important findings. Tronick’s Dyadic Expansion of Consciousness Model will be briefly reviewed—emphasizing his conceptualization of meanings as being composed of multiple commingling layers (biological, psychological, relational, and social) coming together in a nonlinear “messy” mixture of mutually influencing (both bottom-up and top-down) currents. This multilayered model of meaning opens up the reconsideration of an exciting array of technical options—traditionally considered nonanalytic—to be reunderstood as truly psychoanalytic in that they address one or more of the implicit or explicit levels of meaning that a patient makes of his or her self and world. Examples of these interventions include parent work, work with teachers and schools, as well as interventions adapted from other disciplines such as Occupational Therapy. These technical possibilities are illustrated using case material from the psychoanalytic treatment of a nine-year-old boy.     

The Coparticipant Field: Commentary on a Paper by Juan Tubert-Oklander

Psychoanalytic field theory is integral to relational praxis. In his study of the analytic field and its interpersonal complexities and relational intricacies, Tubert-Oklander emphasizes its clinical promise. Tubert-Oklander's field orientation, however, is a conservative and limited one. This commentary proposes a new, more radical coparticipant theory of analytic praxis.

As a unique form of clinical participation, coparticipant inquiry is marked by an emphasis on patients' and analysts' relational mutuality, coequal analytic authority, and dyadic uniqueness. Coparticipant inquiry represents both a one-person and two-person psychology—an integral of classical individualism and the social emphasis of the interpersonal/relational viewpoint. Coparticipant analysis calls for a new, multidimensional concept of the self that reconciles the seeming paradox that we are simultaneously communal and individual beings—from birth embedded in a series of social field, yet always uniquely individual. This psychoanalytic dialectic between personal, nonrelational selfic “I” processes and an interpersonal “me” pattern brings into relational play such concepts as will, self-determination, and agency. Coparticipation promotesatechnically freer, more self-expressive, and spontaneous inquiryandemphasizesthecurativeimmediacyofnewrelationalexperience.

I have believed for a long time that human

nature is a reciprocity of what is inside the skin

and what is outside; that it is definitely not

“rolled up inside us” but our way of being one

with our fellows and our world. I call this field

theory.

—Gardner Murphy     

Is Psychoanalytic Education Effective? Comment on Damsa et al. (2010)

While a growing body of empirical data attests increasingly to the efficacy of psychoanalytic treatment, what data do we have that attests to the effectiveness of psychoanalytic education? In this comment on Damsa et al. (2010), I briefly address that question and suggest that—if we are to truly generate passionate interest in psychoanalysis among psychiatric residents and other mental health professionals in training—perhaps we need to begin by researching the largely unresearched process of psychoanalytic education and supervision.     

Psychoanalytic treatments and empirical research on their efficacy: A commentary

Abstract

The author summarizes the problems inherent in nomological approaches examining the efficacy of psychoanalysis as a form of treatment. He argues that nomologically oriented research operates with assumptions lacking empirical foundation and, moreover, that studies of this type merely give the impression of the effectiveness of psychoanalytic therapies while overlooking the specificity of the psychoanalytic method. He suggests that research into psychoanalytic treatments should not be subjected to a nomological conception of science, and that structural analysis of treatment courses should be examined and systematized within the frame of psychoanalytic treatment theory relative to their outcome. Given this approach, and provided that the theory of treatment is based on conceptual common ground, such studies would enable a prognostic conclusion that psychoanalytic treatments are successful, providing that the sequences generalized in the treatment theory do actually take place in treatments that take patients’ individuality into account.     

Psychoanalysis is becoming an impossible profession within the public welfare system in Sweden

Abstract

The preconditions for psychoanalytic practice within the Swedish public welfare system are analyzed in this article. Psychoanalysis remains a one-to-one treatment and relies on the analyst's capacity to use his or her own subjective response. The development of the psychoanalytic process is dependent on unconscious reality, making it impossible to work with a model that has a strict relation between diagnosis, treatment method, and result. Objectivity and the desire to predict treatment outcomes characterize the immanent logic in the complex system of laws and recommendations that affects most practices within the field of medicine. As a consequence of this development, psychoanalysis and psychodynamic therapy are marginalized, since our treatment methods are not adapted to the present industrialization and economization of the medical health sector, with the result that the preconditions for psychoanalytic training have changed dramatically. The exclusion of psychoanalysis from the national health insurance scheme is a demanding challenge at a time when the Swedish welfare model is undergoing fundamental changes.     

Searching for the enriching sense of otherness: The psychoanalytic psychotherapist as a meaning-bearing other

Abstract

This paper is a theoretical and clinical examination of the patient's search for the otherness of the therapist as a prerequisite for change and development in relational psychoanalytic psychotherapy. A basic assumption is that being in a relationship as well as being a personal self, is to be understood, as being with a “meaning-bearing other”; that is, someone who allows for the possibility of meaningful thoughts and feelings, either through an actual communicative presence or as a consciously, prereflective, or unconsciously imagined communication partner. The term “meaning-bearing other” is used to differentiate distinct, although often synchronic, modes of relatedness. The need for intersubjective “depth”—that is, to discover the otherness of the other, and for oneself to be recognized as an experiencing subject—is regarded as a main motivational force. Winnicott's, as well as Sullivan's developmental approaches, Mitchell and Aron's views on psychoanalytic interaction, and Heidegger and Gadamer's phenomenology and hermeneutics are used as theoretical points of reference for the present discourse. The theoretical points of view are examined and discussed through excerpts from twice-a-week psychotherapy with a six-year old girl.     

Elective mutism in children: A family systems approach

Abstract

Elective mutism in children is a relatively rare symptom which is more prevalent in the kindergarten population and has a higher incidence among immigrant families. Treatment strategies for this silent symptom include speech therapy, behavior modification, psychoanalytic, psychotherapeutic, family systems and a combination of these approaches. This paper reviews the types of elective mutism and proposes common characteristics of elective mutists' families. The potential for a redefinition of the term “elective mutism” is examined. It is concluded that family dynamics are an integral part of the elective mutism problem and need to be considered in a comprehensive treatment plan.     

“I'll Have What She's Having”: Commentary on Paper by Karen E. Starr and Lewis Aron

This discussion utilizes a feminist discourse originating in the 1970s to reconsider Freud's famous question, “What do women want?” and from there explores some hidden dimensions in Starr and Aron's paper concerning female agency, sexuality, and the twists and turns of psychoanalytic theory and social conventions. Highlighting Rachel Maines's researches into the use of vibrators in medical treatment in particular, the discussion illuminates how social conventions function as powerful determinants that legislate what is seen and not seen, what is questioned and what is accepted—and ultimately what is considered psychoanalytic “bedrock.”     

Neuropsychoanalytic Explorations: Linking Practice,Theory, and Research

ABSTRACT

Clinical vignettes along with applicable neuroscientific research findings are considered for the purpose of examining the utility of neuropsychoanalysis to psychoanalytic thought and practice. Several fundamental psychoanalytic concepts are revisited along both lines. Among them are: identification, embodiment, attachment, drive, danger situations, dreams, memory, metaphor, conflict, defense. In the process, the metapsychology of the “mental apparatus” gains renewed attention. The article uses instances of three different clinical situations as moments open to neuro-psychoanalytic explorations of several basic psychoanalytic propositions: on the couch; on the phone; in the chair.     

Only connect: Developmental issues from early to late life

Summary

This paper links aspects of early experience and developmental processes (especially the Oedipus Complex) to troubled states of mind, both in later life and, at length, in the mental predicament of the very elderly — especially in relation to confusion and dementia. The paper draws on psychoanalytic and observational literature, and also on infantile developmental research to trace the ways in which capacities more familiar in the care of infants and young children are especially relevant in extreme old age — eg an understanding of containment, reverie, projective identification, splitting and denial, etc. through a series of detailed observations from within a single family, the paper explores the ways in which psychoanalytic knowledge of early ‘childishness’ may contribute very immediately, even technically, both to an understanding of ‘second childishness’ (to draw on As You Like It) and to how to work therapeutically with these enfeebled states of mind.

Last scene of all, that ends this strange eventful history, Is second childishness and mere oblivion, Sans teeth, sans eyes, sans taste, sans everything.     

The Application of Therapists' Maternal Capacity in Prerepresentational Body-Based Transference and Countertransference

Abstract

The paper explores the maternal capacity of therapists in working with patients for whom developmental deficits render the traditional verbal tools of psychoanalytic treatment ineffective, particularly in the early phases of treatment. Viewed from the perspective of a mother in relation to an infant, the therapist's role is seen as providing a safe holding environment, often in non-verbal ways, for the patient. The capacity of male therapists to access their maternal capabilities is considered. The manifestation of preverbal transference and counter-transference is explored through the presentation of relevant clinical material.     

The Tasks and Traps of Relationships

SUMMARY

This article approaches relationships from primarily a systemic-psychodynamic framework in that psychoanalytic interpretations and assumptions are integrated into a basic systemic orientation The paper focuses on the prerelationship developmental tasks, relationship developmental tasks, the role of love and intimacy in emotional maturity, and the traps and pitfalls commonly encountered by couples, as illustrated by the activation of protective, defensive mechanisms. The material is illustrated by a case presentation. Implications for counseling are considered throughout.     

Visual impressions of active and inanimate resistance to impact from a moving object

ABSTRACT

Images of moving objects presented on computer screens may be perceived as animate or inanimate. A simple hypothesis, consistent with much research evidence, is that objects are perceived as inanimate if there is a visible external contact from another object immediately prior to the onset of motion, and as animate if that is not the case. Evidence is reported that is not consistent with that hypothesis. Objects (targets) moving on contact from another object (launcher) were perceived as actively resisting the impact of the launcher on them if the targets slowed rapidly. Rapid slowing is consistent with the laws of mechanics for objects moving in an environment that offers friction and air resistance. Despite that, ratings of inanimate motion were lower than ratings of active resistance for objects that slowed rapidly. The results are consistent with the hypothesis that there is a perceptual impression of active (animate) resistance that is evoked by the kinematic pattern of rapid slowing from an initial speed after contact from another object.     

Evolution,Altruism, and the Collective Superego

ABSTRACT

Our psychoanalytic understanding of human nature is that humans are self-interested. However, this view differs with those of evolution, ethology, and neuroscience, which show evidence of a natural altruistic capacity. A theoretical foundation for this capacity can be found in psychoanalytic works, particularly those of Melanie Klein. An emerging understanding is that of an altruistic capacity that is induced and shaped by early experience and either fortified or corrupted by social pressures and mental processes. In individuals and in collective society, superego dictates can conflict with natural altruistic impulses. Recognition within psychoanalytic theory of a primary altruistic capacity is important, because we as psychoanalysts have an impact on individual and cultural self-perceptions through our treatment of patients and through our writings and therefore contribute to the shaping of values in our society.     

Where Have All the Psychoanalytic Patients Gone? They're Still Here

Abstract

I develop my argument concerning the question of where have all the patients gone in a sequence of three parts. First, I indicate, very briefly, the nature of the issue and the array of confluent socioeconomic causes—as they are usually outlined—that are held responsible for it. Then I take up the remedy for this problem posed by Arnold Rothstein in his book (1998). which is the trigger to this series of invited commentaries, and I indicate how I both appreciate the merits of his proposal to recast the issue as much as possible within a psychological framework, amenable to psychoanalytic influence, and nonetheless feel his approach to be based on a one-sided, and to that extent, a limited and flawed assessment of the problem, and therefore an only partially useful remedial perspective. And lastly, 1 offer an alternative view of the internal historical developments in psychoanalysis that have played their complementary role in the evolution of this perceived “crisis” and the alteration of perspectives, based on my account of our contending current viewpoints on the nature of the relationship between psychoanalysis and its derivative psychoanalytic psychotherapies, that can perhaps promise a more effective counter to the crisis, despite the multiple external socioeconomic developments that are usually accorded causative primacy and that no doubt are indeed formidable.     

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

Abstract

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

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

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

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