‘The newspaper reader’: On the meaning of concrete objects in a psychoanalytic treatment1

The author investigates the meaning of concrete objects in the psychoanalytic treatment of a severely disturbed patient for the development of his inner world and the analytic process. She includes a survey of relevant theoretical concepts with an emphasis on Winnicott and Bion. It is shown that the objects served basic defensive functions both within the analytic relationship and for the precarious intrapsychic state of the patient. The author describes the technical dealing that led to a structural change. From the comparison of the initial dream and a later dream, Mr N's inner development from total inclusion in the object to triadic reality of separated, repaired objects becomes discernible. The author shows how this progress was facilitated by his use of concrete objects as links between his psychotic and non‐psychotic parts, as well as by the specifi c way the analyst handled the paradoxical transference‐ countertransference. She also illustrates the thesis that the developmental steps described are crucial for the capability to digest psychic pain by symbolization instead of discharging it in a destructive‐violent way.     

On internal object relations

This paper gives an account of the author's attempts to come to terms with the concept of internal object relations, and to find an appropriate theoretical place for it within non-Kleinian mainstream theory. It is proposed that the internal object be regarded as a structure in the nonexperimental realm, being built up during development on the basis of the child's subjective perceptual and fantasy experiences. The internal objects in turn influence perception, thought, fantasy, current object relations, and transference. From the point of view of the clinician, the concepts of internal object and of internal object relation act as useful organizing constructs for both analyst and patient. Finally, the suggestion is made that internal objects can be regarded as the source of internal "presences" with which the person constantly unconsciously interacts.     

Eine Therapiestunde mit einem Mörder

Although psychodynamic concepts may be helpful in identifying the complex interpersonal and manipulative processes that occur between inmates and therapists and to transform them into the therapeutic process they are hardly ever applied in a correctional setting. The author provides an insight into the psychotherapeutic work conducted in prison. The first part of the paper outlines the special conditions in which psychodynamic psychotherapy occurs in a social therapeutic intervention institution within the German prison service. Characteristic transference and countertransference constellations are described. Based on a verbatim report an account is provided of a therapy session with a serious violent offender. In his reflections on the session the author focuses on the effects on the transference process of, in the offender’s eyes, being both therapist and assessor at the same time.     

Freud's 'problem': COGNITIVE NEUROSCIENCE & PSYCHOANALYSIS WORKING TOGETHER ON MEMORY

The first part of this paper discusses the development of Freud's views on memory from the time of the Project up to the formulation of the second topography. Freud's attempts to match his psychological views with an organic model were necessarily inconclusive, but in the process many innovative ideas about memory can be seen to resonate with recent developments in cognitive neuroscience. A brief discussion of perceptual identity, internal perception and Freud's affect theory introduce the central theoretical idea in the second half of the paper, namely that Identification can be seen as a form of memory. Modern memory theory is linked with the superego, following which the author proposes that internal objects might be renamed 'memory-objects' and that these can be understood in terms of the distinction made in cognitive neuroscience between implicit and explicit memory and between different parts of the brain, in particular the amygdala, the basal ganglia and the hippocampus. Klein's 'memory in feeling' and the views of Fairbairn and Ogden in relation to the dynamic nature of internal objects are briefly discussed. The paper ends with a few comments on the aberrations of memory and some implications of the implicit memory-object system.     

Early trauma and affect: the importance of the body for the development of the capacity to symbolize

In this paper I aim to outline the importance of working clinically with affect when treating severely traumatized patients who have a limited capacity to symbolize. These patients, who suffer the loss of maternal care early in life, require the analyst to be closely attuned to the patient's distress through use of the countertransference and with significantly less attention paid to the transference. It is questionable whether we can speak of transference when there is limited capacity to form internal representations. The analyst's relationship with the patient is not necessarily used to make interpretations but, instead, the analyst's reverie functions therapeutically to develop awareness and containment of affect, first in the analyst's mind and, later, in the patient's, so that, in time, a relationship between the patient's mind and the body, as the first object, is made. In contrast to general object‐relations theories, in which the first object is considered to be the breast or the mother, Ferrari (2004) proposes that the body is the first object in the emerging mind. Once a relationship between mind and body is established, symbolization becomes possible following the formation of internal representations of affective states in the mind, where previously there were few. Using Ferrari's body‐mind model, two clinical case vignettes underline the need to use the countertransference with patients who suffered chronic developmental trauma in early childhood.     

The alienness of the unconscious: on Laplanche's theory of seduction

In this paper the author uses a clinical example as a focus for an exploration of his thesis that the parent is the 'other' who implants his or her unconscious message into the child by means of seduction. As the other is alien, the unconscious of the child cannot any longer be considered the centre of the person but is decentred by the implanted alienness. The author draws on Laplanche's seduction theory to argue that the unconscious message of seduction by the other is exclusively sexual and that it cannot be translated nor symbolized because an interpretative system shared by subject and object is lacking. The decentred alterity of the unconscious allows for comparison with a third object and hence a structural triangulation of the mind which is a prerequisite for symbolization. The role of the analyst in permitting a transference enactment and so facilitating the beginning of sexual symbolization is discussed in relation to the clinical example given at the start of the paper.     

Silence as the Voice of Trauma

Silence is a key to the unspoken world of the patient. Rather than interpreting silence as a defensive maneuver, the analyst may understand this disruption as a royal road to the patient’s traumatic experiences. The author proposes to recognize traumatic silences in the analytic process and the transference as a re-experiencing of past, unpredictable traumatic affective states and memories. Silences in this context are both a repeat of a disconnecting experience as well as a manifestation of a silencing identification with the original silencer. The clinical material illustrates effects of a German mother’s World War II (WWII) personal traumata and collective shame-based silence on her daughter’s self and good object development. In the daughter’s analysis, the patient and the analyst, who herself experienced similar WWII traumata, face the pain of trauma recovery and un-silencing. The author suggests that the deadening effect of past traumata may be reversed by an analytic process of re-membering and re-speaking for both the patient and analyst. This allows for a more transparent, subjective experience in the transference and a verbal integration of ego functions.     

Playing and working through: a neglected analogy

The author proposes an analogy between certain features of playing and aspects of working through. Conceptualizing psychoanalysis as the process whereby unconscious fantasy is uncovered and then subjected to rigorous scrutiny, and building on Freud's (1908) insight that play is the same as fantasy--with the essential difference that fantasy links itself to real objects in play, such as toys and playthings--the author proposes that play can be thought of as not merely symbolic, as a fantasy bearer, so to speak, but as a fantasy tester as well. In the process of working through, some analysands attach their unconscious fantasies not only to a transference object, a primary libidinal object, or a significant loved one, but also to actual props within the analytic setting (a Kleenex box, for example), making the analogy with play even more obvious and palpable.     

‘I am not crying. I am rubbing my eyes’: Annie and the hollow object

This article explores the relationship between the development of severe eczema and asthma in an eight-year-old girl and her difficulties with experiencing psychic pain and conflict. The author focuses on the transference dynamics that preceded and surrounded the psychosomatic reaction in the session. The observations in this case may explain why patients, despite feeling taken over by intense physical sensations, can display flatness and superficiality of affect giving the appearance that they are emotionally ‘hollow’. The author proposes that these patients experience an emotional sense of emptiness in themselves and in their objects that is the result of a very early defence of dissociation caused by overwhelming anxieties of annihilation that are lived out in and through the body. The appearance of a psychosomatic symptom during the session can follow the emergence of sudden and intense raw hostile feelings towards the primary object, accompanied by a sense of danger and profound anxiety, as the hated object is also desperately needed for the subject’s own physical/emotional survival. The analyst can contribute to triggering these episodes by failing to contain the patient’s projections, which may lead to the patient feeling forced to re-introject unprocessed and unbearable ‘psycho-physical’ emotions. This article discusses the different degrees – and forms – of symbolic functioning in connection to this girl’s experience of her eczema and asthma and their manifestation in the transference relationship to the therapist.     

Mental models and language registers in the psychoanalysis of psychosis: An overview of a thirteen‐year analysis2

The author suggests that the use of mental models and language registers may help an analysis to proceed, especially in psychosis, when the patient has not yet developed a mental space that will allow him/her the functions of knowledge and containment of emotions. Models, according to Bion, are a primitive approach to abstraction and a manifestation of the analyst's reverie that enables him/her to transform sense data into alpha‐elements. Ferrari, in a further development of Bion's theories, hypothesises a relationship between the transference and the internal level of body‐mind communication, and proposes the use of language registers to sustain the psychoanalytic process. The author presents several clinical examples from a thirteen‐year, four‐session‐a‐week analysis of a psychotic analysand who was initially confused, paranoid and altogether unable to bring self‐reflective thought to bear on her overwhelming emotions and had, by the end of the analysis, completely recovered from her psychotic symptoms. The clinical material shows how the technical tools of mental models and language registers helped in the construction of a mental space and spatio‐temporal parameters, permitting the patient to tolerate overwhelming concrete emotions and finally to recognise and work through the emotions of an intense transference.     

Self-envy and intrapsychic interpretation.

Self-envy is described as the consequence of an early split between different part objects which form the structure of the oedipus complex. This takes place between an excluded destructive child part and another part usually modeled on a harmonic parental couple or on a creative and successful adult. The former will attack, paralyze, or destroy the latter, out of envy within the self. There are three main advantages in using an intrapsychic interpretation: (a) avoiding possible transference collusion in paranoid or perverse borderline structures; (b) eliminating possible persecutory anxiety from superego part objects projected into the analyst; and (c) putting the conflict in the right place, inasmuch as transference is a projection of internal conflicts. Clinical material is presented.     

Working in the borderland: early relational trauma and Fordham's analysis of ‘K’

This paper outlines a view of early relational trauma as underlying borderline states of mind, and argues that Knox's 1999 paper on internal working models and the complex provides a basis for understanding such states of mind. The author argues that in addition to internal working models, the complex also embodies and contains primitive defences of the core self. He outlines how these apply on the objective, subjective, transference and archetypal levels, and in direct and reversed forms and applies this to the account of Fordham's analysis of his patient ‘K’, which ended in impasse. The paper explores the dynamic that emerged in that analysis and suggests that it could be helpfully accounted for in terms of the co‐construction and re‐construction of early relational trauma in the analytic relationship.     

Unconscious phantasy as a structural principle and organizer of mental life: The evolution of a concept from Freud to Klein and some of her successors

Starting with Freud's discovery of unconscious phantasy as a means of accessing his patients’ internal world, the author discusses the evolution of the concept in the work of Melanie Klein and some of her successors. Whereas Freud sees phantasy as a wish fulfilling imagination, dominated by primary process functioning and kept apart from reality testing, Klein understands phantasies as a structural function and organizer of mental life. From their very beginnings they involve object relations and gradually evolve from primitive body‐near experiences to images and symbolic representations. With her concept of projective identification in particular, Klein anticipates the communicative function of unconscious phantasies. They are at the basis of processes of symbolization, but may also be put into the service of complex defensive operations. The author traces the further evolution of the concept from the contributions of S. Isaacs, the theories of thinking proposed by W.R. Bion and R. Money‐Kyrle, Hanna Segal's ideas on symbolization and reparation all the way to the latest approaches by R. Britton, J. Steiner and others, including the understanding of transference and counter‐transference as a ‘total situation’. Points of contact with Freud are to be found particularly in connection with his concept of ‘primal phantasies’. In the author's view, the idea of the transmission and communicative potential of unconscious phantasies enabled these authors to overcome the solipsistic origins of drive theory in favour of a notion in which unconscious phantasies both set down the coordinates of the inner world and form and reflect the matrix of inter‐subjective relations.     

Going home: migration as enactment and symbol

Abstract :  The concepts of home and migration are briefly explored. Reference is made to the reflections of several writers on migration suggesting that migrants may experience alienation, even permanent melancholia. There is discussion of the need to mourn what has been lost and left behind, and of the challenge in analytic work with a migrant to relate to the pain of the individual's core self amid environmental and cultural losses. The paper outlines the history of an individual before her migration from Latin America to London, and tendency to idealize as a new arrival. The symbolization process is discussed and it is suggested that repetitive enactment in the analytic transference may have been needed for her internal reality of estrangement to be confirmed and differentiated from her culturally and socially isolated external life as a migrant. Only then could she mourn losses and symbolize her inner reality. It is suggested that through mourning and symbolization the significance of migration for the patient was worked with and transformed so that, following a second migration, an ordinary, good enough home could be made in a new place.     

The transferential chimera II: some theoretical considerations

The author develops here a theoretical model to account for the different levels of organization and functioning of the transference chimera of which he gave a clinical presentation in an earlier article. From his reading of Jung's 'Psychology of the transference' he derives a dynamic model of the chimera and links it to quantum mechanics and chaos theory not so much to describe the reality of the phenomenon, but to offer a model of representation as a conceptual and meditative tool for analysts to use in their practice. The main hypothesis of this work is that the chimera arises from the intimate interplay of the respective de-integrates of the analyst and of the patient, thus constituting a genuine self in the transference. The author concludes with some implications for the analyst's own internal position.     

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 explosion of the present and the encapsulation of time: Transference phenomena in the analysis of a psychotic patient

The paper deals with some basic problems concerning the experience of time and space in the psychoanalytic treatment of psychotic patients. Whereas borderline patients tend to distort the experience of time and space under emotional pressure, the concepts of time and space seem to dissolve in acute psychotic states of mind. Sometimes this manifests itself in an explosion of the present, where the past is ubiquitous and the future is perceived as the end of all times. The case of a 48 year‐old patient with the external diagnosis of ‘paranoid–hallucinatory schizophrenia’ is presented to illustrate that the main task is to recreate a structure to contain the experience of space and time. Such a development may occur if primitive psychotic anxieties can be taken up and metabolized. A near‐psychotic decompensation before the first break and the development of a transference psychosis in the second year of the analysis are depicted in detail. Subsequently some developments became visible which helped the patient to better tolerate catastrophic fears of loss. This included the formation of a structure which the patient called ‘hibernation’ enabling her to psychically survive without falling apart. By retreating into her ‘time capsule’ she managed to overcome breaks and to delay her fears of fragmentation until they could be taken up and worked through in the transference. The creation of a structure like the patient's ‘time capsule’ is considered to be an attempt to construct the experience of time and space. It prevented a collapse of her internal space thereby enabling further steps towards thinking and symbolization. In conclusion, some theoretical and clinical aspects are discussed including the role of the countertransference.     

The clinical notion of working within

Clinical material is used to illustrate the Modern Kleinian approach to and within a patient’s defensive system and their particular transference profile. Rather than embrace the traditional concept of the working-through (WT) process, the author focuses on the analytic here-and-now of working within a patient’s unconscious phantasy world, the transference, and any pathological organizations that are relied upon. This is a more holistic and comprehensive method of working analytically, based on working within a patient’s internal object relational experience, which hopefully leads to growth and transformation. A summary of the first two analytic sessions with one patient, material from a psychotic patient in treatment for 6 months, and a higher functioning patient seen for more than a year are presented to show the utility of working in this manner with all patients regardless of their level of psychic organization.     

Towards a theory of the integration of the Other in representation

In this article, the author tries to uncover the elements of a theoretical model which would take into account the psychic transformations necessary to facilitate the emergence of representation. Toward this end, he firstly relies on Jung's notion of the archetype and Freud's idea of hallucinatory wish fulfilment, which he reconsiders in the light of the writings of Fordham (de-integration and re-integration of the primary self), and of Jean Laplanche (primary seduction), and linking it to the model based on chaos theory as developed in physics. He thus concludes that under the influence of primary seduction, the archetype is able to become a veritable, strange psychic attractor, enabling the determining factor of the instinctual axis of the archetype to open up to the possibility of symbolization, a necessary underlying feature for the occurrence of subjectivity. He ends his argument with a brief clinical vignette which illustrates the effect of openness to the psychic unknown constituted by primary seduction in the transference.