Symposium on The Ego and the Id after fifty years. Clinical formulations and research.

The Ego and the Id has served as an organizing model which has advanced psychoanalysis as a science and as a therapy. The paradigm offered by the structural formulations provided a framework for many developmental and clinical studies as well as an approach to a general psychology of human behavior. Therapeutic advances have been made, but the art of therapy has not kept pace with the scientific advances. Dissatisfaction with psychoanalysis and psychoanalytic theory is discussed. Theories have become too far removed from their clinical base; a changing sociologic climate that has reduced the impact of the rational attitude offered by psychoanalysis and the failure of psychoanalytic therapy to cure all ills have contributed to the dissatisfaction.     

The idea of a moral psychology: The impact of psychoanalysis on philosophy in Britain1

In this paper the author addresses the question of the significance of psychoanalysis for moral psychology via a more specific question: the impact of psychoanalysis on British philosophy in the twentieth century. He argues that there has been no influence of any real significance, and offers intellectual reasons why not. However, he also argues that there has recently emerged the possibility for a future engagement between psychoanalysis and philosophy, and he offers a history of the emergence of this possibility. In particular, the author discusses how the emerging interest within philosophy to work out a satisfying approach to naturalist moral psychology leads it to a concern with internal mental structure and, most importantly, to transformations of intrapsychic structures. He believes that this will lead philosophy to take a greater interest in psychoanalysis.     

From Application to Approach: A Systematic Review of 50 Years of Psychoanalytic Couple Therapy

ABSTRACT

This systematic review of contributions to peer-reviewed journals in the area of couple interventions aims to provide a comprehensive and intensive overview of this evolving field, within psychoanalysis. Using a pan theoretical systematic review methodology, 113 peer-reviewed journal articles were reviewed, dated between 1963 and 2014, addressing the topic of couple therapy and psychoanalysis. This article addresses a number of specific questions including, where authors have published their work, what methodologies they have used, with which couples psychoanalysts have been working, how writers from within different theoretical orientations talk about their work with couples, and how the field has changed over time. It also explores emerging themes of the relationship between couple and individual therapy, sex, and co-therapy. This review of writing over the past 50 years suggests that although Classical contributions have waned over time, couple psychoanalysts from within Object Relations, Self Psychology, Intersubjectivity, and Relational orientations have evolved in their discourse about couple distress, from an application of psychoanalytic concepts to full-bodied, well-articulated, clear, and concise approaches to diagnosis and treatment. The first 50 years of writing in the field of couple psychoanalysis has brought us distinct treatment models, which have opened the door for greater communication and sharing within and between orientations.     

Dr. Susan W. Gray

While Susan W. Gray is known primarily for her work with the Early Training Project, a pioneering early intervention program with low-income black children, she has also influenced the development of school psychology and the creation of Early Childhood Education as a discipline. In addition, in her own quiet way, she has supported the career development of a number of professional women who have had impact on child development, early childhood education, and school psychology. Four major themes are used to present Susan Gray's biography: (1) being ahead of her time in terms of thinking which allowed her to take advantage of opportunities; (2) the role of serendipity versus long-range planning of career trajectories; (3) specific influences on her as a woman; and (4) a lifetime of courage and dedication. Examples of work which was in advance of psychology included work in early intervention with low-income children, an emphasis on the use of scientific experimental methodology in field research, an eclectic approach which crossed disciplinary boundaries, a consultative approach to school psychology, and the inclusion of affective and cognitive education in inter-     

Toward a Critical Global Psychoanalysis

In light of the contemporary shift away from the universalizing of the Eurocentric perspective, brought into focus with the advent of globalization, it may be useful to consider reorienting traditional psychoanalytic assumptions about human nature to those that are more appropriate to the recognition of a culturally pluralistic world. The author argues that ego psychology originated in the Western Enlightenment's emphasis on liberal individualism, which has limited its applicability across races, classes, and cultures. Relational theories, in their capacity to include the examination of the socially constructed dimensions of the analytic dyad (including race, class, gender, ethnicity, and sexual orientation), offer crucial theoretical and clinical possibilities, lacking in traditional psychoanalysis, that may help analysts to address some of the important cultural sources of psychological suffering. In the relational view expressed here, the unconscious—as made manifest in everyday life and in the transference and countertransference of the analytic situation—is reformulated to include social and cultural influences.     

Nina Coltart and the border of Bethlehem

Nina Coltart's freedom in addressing delicate areas such as spirituality and Buddhism within a psychoanalytic framework has opened borders between different psychoanalytic communities. This paper sets out to identify a deep‐rooted philosophical tension that runs through several aspects of Coltart's work starting from her ‘Slouching towards Bethlehem … or, thinking the unthinkable in psychoanalysis’. In exploring this central topic in depth psychology, of the distinction between thinkable and unthinkable contents, the author argues that it is not a fundamental distinction in Coltart's work but is rather a particular example of a more fundamental structural dichotomy which pervades her approach and which manifests in several different guises. It is the breadth and sincerity of Coltart's writings which make this a useful exercise, not only for understanding the structure of her work but also in illuminating some structural tensions which permeate depth‐psychological pursuits in general.     

Feminism, Psychoanalysis, and Family Therapy: Reflections on Telos

Two of the most significant developments in family therapy since 1980 are the emergence of the feminist critique, and the rediscovery of psychoanalysis as a conceptual source for family therapy. The author has been working to combine the contributions of both feminism and psychoanalysis (particularly object relations therapy) and offers case examples of her clinical work. Telos – an often overlooked aspect of theory – is argued to be the locus of the feminist difference. A call is made for dialogue between feminists and psychoanalytic thinkers within family therapy.     

Janine Chasseguet-Smirgel and psychosexuality - a reminder

Janine Chasseguet-Smirgel, who would have turned 90 this year, had a passion for truth that placed her work at the very heart of psychoanalysis. Never leaving the field of Freudian analysis she explored the inevitable difficulties, due to our premature birth, to become moral subjects. Psychoanalysis was to her, as it was to Freud, a psychology of conflict. She was suspicious of seemingly optimistic views which saw conflict as created between the potentially free subject and one repressive external system or another. Freedom is always limited in psychoanalysis. In an attempt to follow the line of thought in her vast production the article touches upon her critique of Freud’s so called phallic monism, the significance of both parents’place in the psyche, the question of “Falsehood”, perversion as a dimension of the human psyche, and her concerned view on the situation of Western thought today. The author suggests that we might benefit from her radical Freudian stance in a time when the view on truth is undergoing many unfathomable transformations. Perhaps Chasseguet-Smirgels thought can also be an important reminder about the foundations of our work; not just sexuality, not just mental acts but their specific relationship to each other     

Psychoanalytic Couple Therapy: Classical Style

In this essay, the core concepts of psychoanalysis are set forth as the context for the application of classical psychoanalytic theory to the practice of couple therapy. Infantile sexuality and aggression are shown to have a powerful role in the interpersonal lives of family members. The repetition compulsion structures marital interaction and intergenerational dynamics. The intrapsychic emphasis of classical ego-psychology is viewed in the interpersonal arena, and the author suggests adding to the Oedipus and Narcissus myths a myth that resonates with this shift in emphasis. In introducing the “Pygmalion–Galatea process,” the author captures the universal attempt to change the psychic dynamics of the other or others. This ultimately mutual process begins with the infant's mirroring of its caretakers—which includes language acquisition. Much of human interaction is fueled by subsequent attempts to create others in our own images of them and by their reactive compliance or resistance to that dynamic. Three case illustrations are presented to show how these phenomena manifest themselves in marital interaction and in dreams.     

The Politics of Relational Psychoanalysis

Given the foundational premises of relational psychoanalysis, the lack of attention to the social and political world on the part of analytic writers who identify with this orientation is curious. Perhaps relational psychoanalysis itself, particularly in its democratizing impulses (e.g., emphasis on mutuality, concern with questions of authority and self-disclosure), has become a replacement for politics, an effort to provide for patients (and analysts) in the consulting room an experience of a world that no longer seems attainable outside it. The analytic situation thus created would represent a recasting of the world as analysts wish it could be, projected into therapeutic space.

This development in the analytic field is part of a more general cultural shift away from a belief in the possibility of social transformation and a redirection of energies into ameliorative projects. This discouragement dispirits the work of those relational writers who do engage a political aspect in their thinking. The author argues that the recovery of a sense of political efficacy would vitalize analysts' endeavors inside and outside the therapy office and could help to balance the overinvestment of the clinical dimension of psychoanalysis that has accompanied the ascendance of the relational perspective.     

Therapeutic technique in psychoanalysis and psychoanalytic psychotherapy.

As the distinctions between what we consider to be psychoanalysis and what we consider to be psychoanalytic psychotherapy have become more uncertain and more blurred, it follows that it is equally difficult to designate the techniques that would be appropriate and specific for each modality. The problem has been compounded by the fact that in recent years psychoanalysis in the United States has become considerably less homogeneous than in the past and the ego-psychological structural model is no longer the only point of view in the psychoanalytic marketplace. Further, with alterations in the criteria for analyzability, cases which, generally, had not been viewed as suitable for analysis, have been appearing with increasing frequency on psychoanalysts' couches. We have also recognized that the degree of congruence between our expectations from and the results of psychoanalytic treatment was often less than anticipated. It appears that analysts have become considerably less arbitrary about what psychoanalysis is and how a psychoanalysis can be carried out. The author is unable to delineate one technique that is intrinsic to and limited to psychoanalysis. There are, however, differences in degree and emphasis in the ways in which various techniques are applied in the therapy of psychoanalysis as compared to the therapy of psychoanalytic psychotherapy. Special attention is given to the role of a psychoanalytic process and the central place the analysis of resistance plays in psychoanalytic therapy.     

The growth and transformation of American ego psychology

The roots of ego psychology trace back to Sigmund Freud's The Ego and the Id (1923) and "Inhibitions, Symptoms and Anxiety" (1926), works followed by two additional fundaments, Anna Freud's The Ego and the Mechanisms of Defense (1936) and Heinz Hartmann's Ego Psychology and the Problem of Adaptation (1939). It was brought to full flowering in post-World War II America by Hartmann and his many collaborators, and for over two decades it maintained a monolithic hegemony over American psychoanalysis. Within this framework the conceptions of the psychoanalytic psychotherapies evolved as specific modifications of psychoanalytic technique directed to the clinical needs of the spectrum of patients not amenable to psychoanalysis proper. This American consensus on the ego psychology paradigm and its array of technical implementations fragmented several decades ago, with the rise in America of Kohut's self psychology, geared to the narcissistic disorders, and with the importation from Britain of neo-Kleinian and object-relational perspectives, all coinciding with the rapid growth of the varieties of relational psychoanalysis, with its shift in focus to the two-person, interactive, and co-constructed transference-countertransference matrix. Implications of this intermingled theoretical pluralism (as contrasted with the unity of the once dominant ego psychology paradigm) for the evolution of the American ego psychology are spelled out.     

The American Impact on Psychoanalysis

This paper discusses what the author feels are the principal American influences on contemporary psychoanalysis. These include a growing tendency for nonhierarchical relationships in treatment, some extension of freedom of speech to clinicians, a place for management in the structuring of clinical relationships, and an increasing emphasis on aspirations and the future.     

Elasticity of Technique: The Psychoanalytic Project and the Trajectory of Ferenczi's Life

The object of this paper is the Elasticity of Psychoanalytic Technique in the work of Sándor Ferenczi. The author sustains that this can be considered neither as an ultimate arrival point nor as a particular stage of Ferenczi's clinical–theoretical body of work, but rather as an ensemble of affective qualities, attitudes and values, which he gradually developed through experience, signalling a paradigm shift in the history of psychoanalysis. The following areas will be explored: the new sensitivity demonstrated by Ferenczi concerning the relational and communicative factors present in the analytic session, his subtle and acute attention to the participation of the analyst's own subjectivity in the therapeutic process, and how these enduring elements of Ferenczi's technique anticipate several significant future developments in psychoanalysis.     

Review of Awakening the Dreamer: Clinical Journeys by Philip M. Bromberg

The current paradigm shift in psychoanalysis and related sciences is generating more powerful models of psychopathogenesis and treatment. Toward that end, in Awakening the Dreamer Philip Bromberg masterfully integrates psychoanalytic, developmental, trauma, and neurobiological data to explore the bottom-line defense of dissociation. In this review I offer a neuropsychoanalytic perspective of the origin of pathological dissociation, focusing on the enduring impact of this early defense against attachment trauma and its growth inhibiting impact on the development of the biological substrate of the human unconscious, the right brain. Patients with a history of abuse or neglect frequently access pathological dissociation in response to relational stressors to block the emotional pain that accompanies overwhelming affective states. And yet there is a cost. The characterological use of this affect regulating strategy induces a failure of integration of the higher right hemisphere with the lower right brain, thereby inducing an instant collapse of both subjectivity and intersubjectivity in the short term and a blockade of emotional development in the long term. Bromberg's creative book is an excellent example of how effective clinical work with such patients incorporates the current paradigm shift from not only cognition to affect but also repression to dissociation.     

PSYCHOLOGY AND LITERATURE: THE QUESTION OF READING OTHERWISE

By making literature the partner of a dialogue with psychology, with the aim of better understanding the psyche, psychoanalysis has truly altered our way of understanding the literary phenomenon. Thus, Freud resorted to literature in an attempt to validate his theories. At the same time, though, in striving for "natural" scientific status, he shifted the emphasis away from any possible deep comprehension of the literature. However, psychoanalysis, trying to delve deeper into literature, has elaborated a whole theory regarding the literary meaning that is still prevalent today. In this paper, the author examines the Freudian conception of literature that points beyond the intrapsychic and moves towards intersubjectivity.     

Mending the Mind

Cognitive behavior therapy (CBT) offers an alternative paradigm to psychoanalysis for understanding human behavior and the mechanisms of change. Dialectical behavior therapy (DBT) grew out of this tradition conceived originally for the treatment of suicidal patients with borderline personality disorder. Unlike psychoanalysis, DBT does not recognize unconscious meanings or motivations and instead focuses on sequences of measurable behavior and the contingencies that reinforce them. The treatment protocol emphasizes a deficit model and is structured around specific targets and goals combined with “skills” training (i.e., specific skill sets to help with emotional, cognitive, and behavior dysregulation) Combining an overarching dialectical philosophy, emphasis on the therapeutic relationship and mindfulness, DBT offers a comprehensive therapeutic approach including individual sessions and group work.

The directive methods of CBT have often been viewed as antithetical to analytic reflection; such active therapeutic techniques on the part of the psychoanalyst are often seen as impeding the necessary free associative processes necessary for the acquisition of insight and for change. Whereas psychoanalysts help patients recognize dysfunctional patterns of behavior within the transference and alternative ways to view the transaction, they often do not help a patient implement new behaviors into their lives in systematic ways.

Both psychoanalysis and DBT have much to offer and to gain. In time translation and mutual inclusion of new ideas may help bridge the gap.     

What does the child analyst bring to Jungian thought?

The author wants to show the influence that the historical acknowledgement of child therapy at the Jerusalem IAAP Congress in 1983 has had today on the Jungian world, especially on the clinical approach to their patients by analysts working only with adult patients. If her conclusions do not allow her to dissociate the strong influence on psychoanalysis of contemporary research on attachment theory and mother-child relationship from a specific Jungian child therapists' perspective, she points out, through three examples from Jungian literature, how the need for a metapsychology of development and the study of primary and personal aspects of the patient's life are explicit in the work and research of analysts working with adults.     

The Hofgeismar Lectures: A Contemporary Overview of Horneyan Psychoanalysis

Part I of this paper describes Karen Horney's theory of neurosis. In the 1930s, Horney repudiated Freud's view of female developmental psychology. She argued that cultural factors rather than anatomy or innate biological drives were the primary determinants not only of female development but of personality, as well. When genetic and environmental circumstances together lead to basic anxiety early in life, she believed a deep inner conflict emerges in the individual leading to the need for elaborating layers of rigidified protective defenses. She called this the neurotic process. This process can result in discrete symptoms of mental disorder as well as the more generalized problems of alienation from the person's real self and reliance on neurotic solutions. In Part II, the practical application of Horney's theory to clinical work is demonstrated in a case presentation of a notably timid and perfectionistic man. Part III points up elaborations of Horney's theories by later workers of her school, the American Institute for Psychoanalysis, and provides a history of her school within the broader context of American psychoanalysis. The author's emphasis on postmodern and narrativist elements of Horneyan psychoanalysis are illuminated, as well.     

THE PSYCHOANALYTIC CONTRIBUTIONS OF MELITTA SCHMIDEBERG KLEIN. MORE THAN MELANIE KLEIN’S REBEL DAUGHTER

Compared to the impact of the work of Melanie Klein on the history of psychoanalysis, the contributions of her daughter, Melitta Schmideberg, passed almost unnoticed. At present, Schmideberg is solely remembered for having harshly attacked her mother at the start of the Controversial Discussions of the British Psycho-Analytical Society and for having coined the fitting expression “stable instability” in order to describe borderline and asocial personality disorders. However, the author discusses how the early groundbreaking discoveries of Klein with regards to primitive anxieties were the result of the joint work and thinking of Melanie and Melitta. Moreover, he argues that the conflict between the two, along with the subsequent polarization of their views, did not facilitate the development of psychoanalysis, neither did it help the analytic community to recognize the value of Melitta’s contributions to psychoanalysis.