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.     

Commentary on Paper by Lawrence J. Brown

Brown's historical overview of post-Kleinian psychoanalysis traces key steps in the evolving and diverse practice of working in the psychoanalytic situation while regarding it as a two-person field. The Barangers' “The Analytic Situation as a Dynamic Field” is central to his narrative. I develop my understanding of the originality of their contribution in theorizing a situational unconscious, and of their continuing relevance for thinking about analytic listening and intersubjective collaboration. Brown presents a countertransference dream of his own along with the dream of a patient as an example of the Barangers' concept of the “shared unconscious fantasy” of the analytic couple. A detailed alternative reading of Brown's clinical vignette reveals an absence of fit with the Barangers' views on collaboration in the analytic situation. Some uses of Bion's “dreaming” and “becoming” are implicitly questioned as they risk encouraging the idealization of special states over process.     

Regulation and standards for psychoanalysis: The place of the Other in psychoanalysis and its teaching

In numerous Western countries, psychotherapies have come under increasing governmental regulation. A more recent development is the increasing scrutiny given to psychoanalysis in the United Kingdom, in France, and in the United States. This paper examines a particular document that was created by four professional psychoanalytic organizations that are based in the United States. The document called Standards of Psychoanalytic Education aims to develop criteria that would guide accreditation and the organization of psychoanalytic institutes. The document is part of a set of concerns and actions related to the state regulation of psychoanalytic practice, its professional status, and the protection of those who seek its services. The essay examines the putative theoretical neutrality of this document by unfolding its tenets in terms of Lacanian psychoanalysis, a school of psychoanalysis that would take exception to many of the ideas suggested in the document's template for psychoanalytic education. The paper follows one line of argumentation throughout: what is the place of the Social Field, the Symbolic Other, within psychoanalytic process and as a recourse for professional legitimization that stands outside of psychoanalysis? As a practice of particularity, what relation does the discipline bear to other mental health fields and to the norms and knowledge systems of the mental health professions? Using a Lacanian orientation, two senses of the Other are discussed, and the specificity of psychoanalysis is asserted. This specificity is contrasted with some of the goals and constraints that are introduced by current approaches to regulation.      

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.     

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.     

Conflict in psychoanalysis and in life

Abstract

Unconscious conflicts are at the center of Freudian psychoanalytic inquiry, in the psychoanalytic situation as well as in the theory of personality and pathogenesis. The core dynamic formulation, intrapsychic conflict resulting in new psychic formation, is addressed in the paper in the following steps.

First, the development of the concept of conflict throughout the history of Freudian psychoanalysis is reviewed. Next, the analytic and synthetic aspects of conflict theory are explored and the role of conflict in the development of personality organization and pathogenesis is clarified. Then, the contemporary extensions and elaborations of structural theory are presented.

To illustrate analysis focused on conflict, clinical material covering the phases of psychoanalytic process is highlighted. From the beginning stage of analyzing the patient's initial diffuse state of indifference and “weirdness”, analysis proceeds to address primary and secondary symptoms of impotence and exhibitionism and underlying passive-phallic personality organization with conflict around aggression. This leads to the patient's sense of mastery over previously enslaving and “immobilizing” internal turmoil.     

Our Literature as the Problem Child of Psychoanalysis Commentary on Paper by Drew Westen

This paper is a response to an essay by Drew Westen. The author agrees with many of Westen's arguments about problems in the psychoanalytic literature and adds that the psychoanalytic literature has always been a problem for psychoanalysis. If we think of psychoanalysis as an ongoing experiment, then its “trials” are all the analytic sessions that have been conducted. Our “literature” has never systematically drawn on those. Westen critically scrutinizes certain habits that, in his view, haunt our literature, but that we do not explicitly note or disown as conceptual contrivances we mean to get rid of, while they are often misguiding clinical thinking and practice. I suggest that a fascinating question riding below the waves of Westen's paper is why patients and analysts accept this situation. I suggest that we all treat psychoanalysis as wisdom, art, relationship, skill, and something other than the application of established scientific findings because we recognize and accept it as that kind of human activity. It is unclear if patients care whether or not their analysts are scientists, but it is clear that analysts are not optimistic about sifting the research literature and finding clear clues to more effective clinical thinking, work, or writing.     

Free-associating with the bodymind

Abstract

The history of attitudes toward Freud's adoption of free-associative discourse, as well as toward the significance of the clinical significance of the free-associative method, is critically reviewed. It is argued that, if one takes the re-inviting of repressed contents back into self-consciousness to be the defining process of psychoanalysis as a discipline (distinguishing it even from those psychotherapies that are based on psychoanalytic models of the mind), then free-associating is indeed the sine qua non of the psychoanalysis process. It is further suggested that whereas Freud's notion of libidinality radically subverts Cartesian dualism, our thinking about the significance of free-associative discourse has too frequently lapsed into the mistaken assumption that free-associating should only be about what “comes to mind.” In this context, a way of free-associating with the “bodymind” is described as an addendum to customary psychoanalytic practices. This augmented method remains faithful to Freud's practice of allowing the voice of sensuality to “join the conversation,” at the same time that its clinical implementation incorporates some of the wisdom concerning “breathwork” that comes from the yogic procedures for cultivating awareness.     

'Talk to me baby, tell me what's the matter now': Semiotic and developmental perspectives on communication in psychoanalytic infant treatment

Infants suffer to a considerable degree from disturbances in nursing, sleep, mood, and attachment. Psychotherapeutic methods are increasingly used to help them. According to case reports, psychoanalytic work with infants and mothers has shown deep‐reaching and often surprisingly rapid results, both in symptom reduction and in improved relations between mother and child. The clinical urgency of the method makes it important to study its results and theoretical underpinnings. Among the theoretical issues often raised in discussions on this modifi ed form of psychoanalysis, those addressing the nature of communication between analyst, baby, and the mother are the most frequent. For example, how and what does an infant understand when the analyst interprets to her? What does the analyst understand of the infant's communication? These issues are addressed by investigating the infant's tools for understanding linguistic and emotional communication, and by providing a semiotic framework for describing the communication between the three participants in the analytic setting. The paper also investigates problems with the traditional ways of using the concept of symbolization within psychoanalytic theory. The theoretical investigation is illustrated by two brief vignettes from psychoanalytic work with an 8 month‐old girl and her mother. demand for the breast. Like the two lovers in the blues, they seemed to be slaves to     

To Be Is to Betray: On the Place of Collective History and Freedom in Psychoanalysis

This paper explores an open frontier between psychoanalysis and critical theory, the relations between subjective experience and collective history. Its drive is a concern with the question of freedom: How might contemporary psychoanalysis help us think about freedom? How could it, as a practice, help us to be free? On the theoretical level, the paper follows the critique of psychoanalysis offered by Foucault and Adorno, particularly the latter's close reading Ferenczi in Negative Dialectics and his notion of “the spell.” I employ their critique in order to articulate the dilemma psychoanalysis faces vis-à-vis the notion of freedom in social context. I argue that, unlike traditional psychoanalytic discourse, relational psychoanalysis can address this dilemma in a generative way. I find this prospect in the readiness of relational psychoanalysis to realize the potential inherent in the psychoanalytic setting: the creation of a mutually constituted intersubjective space. I tell the story of a young woman for whom love seems impossible, and of a psychoanalytic expedition that finds her ability to love being held hostage. I suggest that what appears in one register as gender and sexual trouble appears in another as a dilemma of attachments and loyalties: my patient's ability to love is spellbound, trapped in a subjective-collective no man's land between her desire to be for herself and the unconscious demands of collective heritage. I argue that for psychoanalysis to be a practice of freedom, it must address the ways in which subjective experience answers to social forces and collective history. I question in this context the relations between freedom, guilt, and responsibility. Re-engaging Adorno, I agree that selfhood may always involve a guilty betrayal of others but argue against him that we must allow this guilt to be reconciled with living. I suggest, in conclusion, that theory is the bearer of collective responsibility.     

Relational Psychoanalysis: A Review

Relational psychoanalysis, a relatively new and evolving school of psychoanalytic thought, is considered by its founders to represent a “paradigm shift” in psychoanalysis. The relational approach, initiated by the publication of Jay Greenberg and Stephen Mitchell's book, Object Relations in Psychoanalytic Theory in 1983, has developed into a movement with its own substantially separate literature. This paper reviews both the history and theoretical origins of the relational movement, as well as important theoretical premises and viewpoints now associated with the relational school.     

Dreams in Child Psychoanalysis

More than six decades after Freud's death, psychoanalysts are certainly not more unified in their view of the concept of the unconscious—its structure and its way of working—than in ‘the good old days’. Challenges are facing psychoanalysis from many perspectives, urging psychoanalysts to continuously reconsider their theoretical grounds. This paper pursues three lines of argumentation concerning the Unconscious. The first line concerns the relation to neuroscience and this paper suggests the concept of background feelings (Damasio) as a contribution to another understanding of deficits in the psychoanalytic relationship. The second line concerns the relation to cognitive semiotics, and here, the paper stresses the concept of basic image sehemata as a possible link between the subject's pre-reflective awareness of the other and the internal world of phantasy. The third line pursues a concept of the analytic interpretation which is close to the Freudian idea that psychoanalysis is the communication between two Unconscious, and, consequently, that the psycho-analytic interpretation is not per se a conscious act.     

From Resistance to Analytic Truth

“Resistance” in psychoanalysis from its inception has meant the patient’s opposition to and interference with the analytic process that must be followed to resolve the patient’s neurosis. This concept of “resistance” implies the analyst possesses an objective truth about the patient and the therapeutic action of the process. Without that assumption, the concept itself is meaningless. It is argued that the concept of objective truth is inapplicable to any study of the human process, such as psychoanalysis, so resistance is not a defensible concept for the field. However, the commonly proposed alternative, relativism, leads to solipsism and therefore is also not a viable epistemology for psychoanalytic investigation. The concept of analytic truth is proposed as a third way that avoids the pitfalls of both objectivism and relativism. It is argued that when the patient opposes what the analyst regards as a self evident truth, an especially difficult type of enactment is occurring. The clinical approach to extricating the analytic pair from the strangulated enactment of clashing viewpoints is illustrated with the case of a young man who “never got angry.”     

FROM EXTENSION TO REVOLUTIONARY CHANGE IN CLINICAL PSYCHOANALYSIS: THE RADICAL INFLUENCE OF BION AND WINNICOTT

This paper addresses the radical departure of late Bion's and Winnicott's clinical ideas and practices from traditional psychoanalytic work, introducing a revolutionary change in clinical psychoanalysis. The profound significance and implications of their thinking are explored, and in particular Bion's conception of transformation in O and Winnicott's clinical‐technical revision of analytic work, with its emphasis on regression in the treatment of more disturbed patients. The author specifically connects the unknown and unknowable emotional reality‐O with unthinkable breakdown (Winnicott) and catastrophe (Bion). The author suggests that the revolutionary approach introduced by the clinical thinking of late Bion and Winnicott be termed quantum psychoanalysis. She thinks that this approach can coexist with classical psychoanalysis in the same way that classical physics coexists with quantum physics.     

An Analyst Has a Birthday - Can Forgiveness Heal?

Forgiveness is a challenging endeavor in human experience and in clinical work. Is it an important and/or legitimate analytic concept? Long the province of theologians and philosophers, forgiveness has had little theoretical place in the psychoanalytic lexicon. This paper considers the analytic place of forgiveness through a treatment that was shadowed by two lost mothers – the patient’s and analyst’s - in the consulting room. The patient’s question, “must we forgive to heal?” will be examined in this story of healing for both him and his analyst.     

Response to Strenger

Despite certain apparently common values, Strenger's critique is addressed largely to an inaccurate account of my views. It is also internally contradictory in various ways. On one hand, for example, Strenger favors a dialectic of science and the humanities as they bear on psychoanalysis; on the other hand, he declares science to be the exclusive psychoanalytic “metaphysic.” Remarkably, he claims that my critique of technical rationality is tantamount to advocating a passive reflective stance on the analyst's part, precluding anything akin to “coaching” to foster change. But I've written consistently about the dialectic of proactive therapeutic influence and critical reflection on that very influence and its implications. What's unacceptable about technical rationality is its positivist confidence about the effectiveness of prescribed interventions based on allegedly scientific evidence. With his lengthy survey of extra-analytic studies, Strenger evades engaging my specific arguments since they are strictly about the unwarranted privileging of the findings of psychoanalytic process and outcome research relative to clinical experience. He mistakenly equates my repudiation of such privileging with rejection of the value of “science” altogether for psychoanalysis. Finally, Strenger's claim that my “dialectical constructivism” eschews formulating universal truths about human nature ignores my consideration of human potentials for both denying and confronting mortality and the associated challenge of human agency. Embracing that challenge constitutes a moral position for psychoanalysis that is unequivocally opposed to uncritical compliance with culturally shaped demands for various types of therapeutic services.     

The uses of humor in life,neurosis and in psychotherapy: Part 2

Abstract

The first part of the paper focused on the dynamics of wit in life, literature, and psychoanalysis; the second part of this paper is devoted to the use of humor in therapy. The central concept is Freud's psychoanalytic method, as distinguished from Freud's various theories of disorder, or neurosis, with a further elaboration of Freud's inherently interpersonal conception of the analytic process, already present in the cathartic phase of the therapeutic technique. The cathartic, or discharge, function of humor is connected to reciprocal free association (a term coined by the author) to define the mutual and reciprocal free association in analysand and analyst, playing an essential role in the genesis of insight and interpretation. Humor has its role in loosening repression, facilitating the emergence of unconscious emotions and ideas, bringing to light character defenses, and thus driving the process of analysis.     

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.”     

The neglected object: A history of the concept of dreams in Polish psychiatry and psychology in the interwar period, 1918–1939

The development of the concept of dreams in interwar Polish psychiatry and psychology was influenced by Western European concepts as well as by sociocultural factors of the newly independent state. Few Polish psychiatrists addressed the subject of dreams. They were influenced mainly by Sigmund Freud's psychoanalytic concept of dreams, but also by Alferd Adler's, Carl Gustav Jung's, and Wilhelm Stekel's ideas. Nevertheless, they approached psychoanalysis critically. The most comprehensive concept of dreams in Polish psychiatry was oneiroanalysis by Tadeusz Bilikiewicz. Oneironalysis was a method of dream analysis based on psychoanalysis but it rejected the psychoanalytic method of free associations and challenged psychoanalytic approaches to the interpretation of dream symbols. Polish psychologists were even less interested in dreams than psychiatrists. Problems with dreams, the most elaborate psychological work by Stefan Szuman consisted of an outline of epistemological problems with general theories of dreams and a harsh critique of psychoanalysis. The neglect of the subject of dreams in Polish psychiatric society can be seen as connected with the social and professional reception of psychoanalysis in Poland. Psychoanalysis was met with opposition from conservative scholars and publicists presenting nationalistic and anti-Semitic attitudes. It was also criticized by the biologically oriented majority of psychiatrists of the Polish Psychiatric Association. In the case of psychology, the most influential Polish psychological school, Lvov-Warsaw School, promoted Brentanian intentionalism, introspection, and psychology of consciousness, therefore, leading to psychologists' reluctance to explore unconscious states like dreams.     

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.