Transference and relationship: Technical Implications in the psychoanalytic process with a borderline patient

This paper reviews how the bond between the therapeutic relationship and transference is created, illustrates its technical management, and provides a basic methodology for the exploration of both transference and the therapeutic relationship. For this purpose, the current therapeutic relationship, the concept of affective dominance, the object relation triggered by transference, the past and present unconscious, and the relationship pattern (CCRT) applied to dreams will all be considered. The approach in this paper is based on an object relation conceptualization. Highlights of the theory underlying the technique will be illustrated in a succinct discussion of the clinical treatment of a borderline patient in psychoanalysis.     

On psychoanalytic autobiography

This article considers how one might define ‘psychoanalytic autobiography’, using statements from theorists of ‘life-writing’ and extracts from autobiographers (some of them psychoanalysts), together with their own commentaries on the genre. The focus is less on content and more on the nature of the art form, with a view to noting analogies with the psychoanalytic process. These analogies are to be found, in particular, in the qualities of transference dialogue; in the art of transformative or communicative projective identification; and in the contrast between self-indulgent and constructive types of memory. Psychoanalytic autobiography is seen as a mode of remaking the self – not omnipotently but through exploratory self-analysis, frequently following the familiar pattern of loss and rediscovery. It entails a special imagined relationship with the unknown reader, and a sense of being guided by a detached observational eye equivalent to that which Bion terms the ‘third party’ in a psychoanalytic situation.     

Dream actors in the theatre of memory: Their role in the psychoanalytic process2

The author notes that neuropsychological research has discovered the existence of two long‐term memory systems, namely declarative or explicit memory, which is conscious and autobiographical, and non‐declarative or implicit memory, which is neither conscious nor verbalisable. It is suggested that pre‐verbal and pre‐symbolic experience in the child's primary relations is stored in implicit memory, where it constitutes an unconscious nucleus of the self which is not repressed and which influences the person's affective, emotional, cognitive and sexual life even as an adult. In the analytic relationship this unconscious part can emerge essentially through certain modes of communication (tone of voice, rhythm and prosody of the voice, and structure and tempo of speech), which could be called the ‘musical dimension’ of the transference, and through dream representations. Besides work on the transference, the critical component of the therapeutic action of psychoanalysis is stated to consist in work on dreams as pictographic and symbolic representations of implicit pre‐symbolic and pre‐verbal experiences. A case history is presented in which dream interpretation allowed some of a patient's early unconscious, non‐repressed experiences to be emotionally reconstructed and made thinkable even though they were not actually remembered.     

An overview of the treatment of severe narcissistic pathology

This paper provides an overview of narcissistic personality disorders as they present clinically along a spectrum of severity ranging from the best functioning forms of pathological narcissism to the most threatening to the patient's psychosocial and physical survival. It proposes a general interpretive psychoanalytic stance with all these clinical syndromes that range from standard psychoanalysis to a specific psychoanalytical psychotherapy for the most repressive and life threatening conditions that may not respond to standard psychoanalysis proper. This general psychoanalytic approach is placed into the context of related developments in contemporary psychoanalytic understanding of pathological narcissism and its treatment.     

Rebirth fantasy and the psychoanalytic process

In this paper, Jungian and Freudian perspectives on the fantasy of rebirth are explored and a brief review of the literature on the theme is used to show how that the rebirth fantasy seems to be a universal fantasy in the human mind, connected with the experience of both destruction and creation. In the psychoanalytic process the rebirth fantasy is connected with initial hopes for a better life, but is also a vehicle for creating the analytic pair and for separating from the 'totalitarian object'. An account of clinical work with a patient is given to illustrate the mutual and parallel process of rebirth in both the patient and the therapist. For the patient, the therapy was experienced as an awakening or a birth. The therapist was initially doubtful about the patient's capacity to engage in the analytic process but his involvement and interest were 'born' during the early sessions, enabling the patient to rely on him to lead her out of the claustrophobic power of the totalitarian object.     

Group supervision and the psychoanalytic process

This article attempts to elucidate the psychodynamics of group supervision of group psychotherapists. The significance of the supervisory setting is explored with a particular emphasis on the frame. The regressive interactions in group supervision are regarded as enactments, which are conceptualized as nonverbal communications that are covertly transmitted. Enactments offer a link between the present group (supervisory group) and the absent group (the therapy group that is being supervised). The relationships between the experiential and didactic components of group supervision are also addressed. Clinical vignettes illustrate the interplay between the present and the absent group focusing on the supervisor's interventions.     

Conceptualizations of the psychoanalytic process

A demonstrable psychoanalytic process involves elaborate and sustained intrapsychic experiences and phenomena for both analysand and analyst. It also includes a complex and at times subtle interpersonal relationship in which each participant is actively sensitive and responsive to verbal and nonverbal input from the other. These interpersonal experiences stimulate further intrapsychic responses which in turn may have further interpersonal effects. Within the framework of the psychoanalytic situation, these combined intrapsychic and interpersonal responses lead first to facilitative and ultimately to definitive changes in the patient's psychological organization and function. A method for demonstrating a psychoanalytic process is described.     

Repression and splitting in the psychoanalytic process

The authors examine the concepts of repression and splitting and their interplay during the psychoanalytic process. Initially, repression was introduced by the clinical phenomenon of resistance, leading to the formulation of the association between intrapsychic conflicts and neurotic symptoms. Later, repression was linked to normal development and to personality organization. Splitting, on the other hand, has been defined in quite diverse ways. The two main definitions are of splitting within the ego, and splitting of representations of the self, and of internal and external objects. Repression and splitting are compared developmentally, dynamically, and with respect to their relationship to psychic functioning and energic conditions. Clinical material is presented from the analysis of a patient who presented with borderline personality organization and narcissistic features. During the initial phase of analysis, splitting associated with projection, projective identification and idealization were the main defence mechanisms. As the analysis progressed and the themes of omnipotence and mourning were explored with the simultaneous working through of drive derivatives expressed in the transference, repression gained ground over the more primitive defence mechanisms. The evolution of the case showed a gradual shift from splitting to repression and the association of repression with a more advanced psychic organization. This development reflected the dynamic movement from borderline to hysterical organization in psychoanalytic nosology.     

Alienating identifications and the psychoanalytic process1

The transmission of psychic life from one generation to the next can result in unconscious, alienating identifications when the parents have not been able to elaborate a process of mourning for their own childhoods. In this article, the author describes the nature of these identifications, constructed around insufficiently symbolized experiences, as revealed during the psychoanalytic process. These unconscious, alienating identifications raise some arduous technical problems for the psychoanalyst as they lead the patient to carry out complex enactments that erase the normal transference markers. The psychoanalyst may then be tempted to resort to pejorative theoretical concepts, such as the death drive. And yet, unknown to the analysand, the insufficiently symbolized psychic elements contain a potential for transformation that may lead to reconstructions and dis‐alienating interpretations. The author distinguishes between alienating identifications and fantasies of identification when the latter transiently appear during the psychoanalytic process. These identification fantasies symbolically register the emotional experience undergone during the analytic sessions and contribute to the integration of insufficiently symbolized psychic elements. These theoretical considerations are fully illustrated by the clinical report of some analytic sessions.     

Defense and resistance in the psychoanalytic process

"Defense" and "resistance" are usually regarded as two separate and distinct concepts, the first belonging to psychic functioning in general and the second to therapy, yet this distinction is far from constant. Clinical observations indicate a frequent overlapping of these two mental functions or positions. A patient's behavior may convey the meaning of either or both concepts, and a position or response that one assumes to bespeak resistance may reveal defense instead. This state of affairs may be seen in the analysis of patients with a relatively well-integrated neurotic identity, but its main import is in the analysis of psychosomatic patients and those with severe personality disorders. Insufficient holding experiences during the infancy of these patients do not enable them to develop functional structuralization. Deficient mothering in the first stages of life also prevents the stable differentiation between defense against threats from within and resistance against influence from outside.     

Future and potentiality in the psychoanalytic process

A perspective is delineated on the dimension of the future in the psychoanalytic situation. Clinical manifestations are presented of the tension between actuality and potentiality that characterizes the treatment situation. This tension, an aspect of the intersubjective field that exists between patient and analyst, involves the analyst's hopes, expectations, anticipations, sense of purpose, and therapeutic intent, facets of the analyst's subjectivity that affect the clinical process. The question of the patient's individuality and autonomy is raised in the context of the notion of the "true self." To understand potentiality in the clinical situation, it is argued, the intersubjective emphasis on the inevitable mutual influence between analyst and patient must be complemented by a view of the self as emerging from within and gaining coherence through the unfolding of inherent dispositions and potentialities.