Psychoanalysis in later life

After decades of heeding Freud's admonition against taking patients older than fifty years of age into psychoanalytic treatment, psychoanalysts began to treat them and to report encouraging experiences. This essay is another in a series of case reports that confirms and extends the nature of changes possible in the analytic treatment of elderly patients. In order to demonstrate both specific changes and the possibility of satisfactory terminations with patients of advanced age, the author describes his analytic work with a woman who first consulted him when she was sixty-eight years old.     

A Plea for a Measure of Cautious Optimism: Reply to Book Reviews

The author responds to four reviews of his book Impossible Training. He describes how the book came into being, discusses his attitude to the Freud—Ferenczi and Klein—Winnicott debates, and raises the dangers of rigid views as to what is truly psychoanalytic and what is truly relational. The global scene of psychoanalytic training today is discussed. It is suggested that critiques do have an impact on psychoanalytic education and that in spite of its flaws and inner contradictions, this education raised generations of sophisticated thinkers and sensitive clinicians.     

Mein Konzept der Supervision

The reflections on supervision presented in this paper were written against the background of a psychoanalytic training. The paper describes what – in the author's view – characterizes a patient in psychoanalytic psychotherapy, a psychoanalytic therapist, and a supervisor. In addition, the author reports on his personal experiences which he has made with supervision in the course of his activity as a psychoanalyst in the roles of supervised and supervisor. In this context, he presents some actual memories from supervisory experiences with M. Balint, H. Argelander and F. Morgenthaler.     

The mind: psychoanalytic understanding then and now

The author discusses the evolution of psychoanalytic understanding from Freud's time to the present, citing the influence of various sociocultural changes. He addresses Freud's proper place in history and notes ways in which Freud's contributions cast him as belonging to Romanticism. Freud's shift from the topographic model of the mind to the structural one, and the influence of this on psychoanalysis, is discussed, as well as important developments in the field since Freud. The author focuses particularly on difficulties encountered in psychoanalytic practice today, and he describes what he has termed organizing interpretations as uniquely valuable in the treatment setting.     

"Switch Him On!"

In this article, the author describes somber scenes that have been extracted from Brazilian reality. Some of the elements that compose these scenes have been analyzed as to their relation with contemporaneity and psychoanalytic topics of interest: perversion, helplessness, pain, life instinct, death instinct, humor and indifference.     

Über das Spannungsverhältnis von Psychoanalyse und Berufspolitik

Taking the inherently conflicting relationship between psychoanalysis as a science of the unconscious and reality as her starting point the author describes the historically developed need of an extensive political commitment as a genuine task of the psychoanalyst to ensure the own group’s survival within health system in the long run. The author illustrates her argument by the numerous changes, which have been introduced into the field of professional and social law within in the last 12 years and affected clinical practice within the legal health insurance system as well as psychoanalytic training. She describes the area of tension in which politically committed psychoanalysts find themselves. These tensions are produced by a frequently met defence fuelled by anxieties and denial of the own colleagues against professional politics within psychoanalytic organisations and by various defences in extraanalytical professional politics. The author discusses ways of an individual, intrapsychical mastering both on part of colleagues committed to professional politics and of members of analytic organisations and describes ways of institutional dealing with these conflicts in psychoanalytic organisations and in the extraanalytical field of professional politics as a precondition of a more successful representation of the own group’s political interests. Finally she considers structural changes which are necessary if psychoanalysis is to succeed not only in the struggle about distribution of resources but also in the interdisciplinary scientific debate.     

A Buddhist contribution to the psychoanalytic psychology of self

The author attempts to integrate the concepts of self used in psychoanalytic theory with the understanding of the nature of self as explained within the Buddhist meditative tradition. He divides different concepts of self in psychoanalytic theory into three major levels of consciousness and abstraction: self as experience, representational self and self as system. The representational level is defined as consisting of unconscious organizing structures of interaction: the system level is a hierarchically higher organization of representations, while the experiential level consists of the moment-to-moment flow of consciousness. He argues that for the sake of theoretical clarity these levels should be differentiated in discussions of self. He then describes the Buddhist psychology of self and tries to show how this perspective can enrich psychoanalytic understanding of the experiential self and of narcissism, which in Buddhist language would be described as clinging to (seeking or avoiding) images of self that arise in the mind. Last, he describes a model of therapeutic development using different levels of self and the interrelationship between them, showing how psychoanalytic psychotherapy and Buddhist insight meditation emphasize different levels of self using complementary rather than mutually exclusive methods.     

A Psychoanalytic Moveable Feast

The author describes his development as a psychoanalyst. He describes the weaving of his formative experiences into a source of motivation in the pursuit of psychoanalysis as a vocation. He describes the gradual development of the ability to utilize the synergism of the evolution of his self-analysis, clinical experience, and psychoanalytic knowledge in the evolution of his work as a psychoanalyst.     

Mothering Adolescent Daughters: A Psychodynamic Perspective

The psychology of motherhood during the daughter's adolescence is described in this article. Drawing on psychoanalytic and Jungian theoretical works as well as on research in adult development, the author describes (a) normal maternal development with an emphasis on the synergistic, maturational tasks of the mother and adolescent offspring; (b) maternal conflicts; and (c) counseling approaches that promote the mother's individuation and appropriate responses to her child.     

Subjectivity, objectivity, and triangular space

The author reviews his ideas on subjectivity, objectivity, and the third position in the psychoanalytic encounter, particularly in clinical work with borderline and narcissistic patients. Using the theories of Melanie Klein and Wilfred Bion as a basis, the author describes his concept of triangular space. A case presentation of a particular type of narcissistic patient illustrates the principles discussed.     

The so-called rule of abstinence revisited

The paper discusses whether the rule of abstinence is still valid in the contemporary theoretical arena of psychoanalysis. Not only is this a debate on principle. It also raises the question of how gratifying the analyst should be in the analytic encounter, still remaining within the psychoanalytic paradigm. Current criticisms of the concept of abstinence are reviewed. The author replies to the objections. He argues that the so-called rule of abstinence is not a “rule” which describes the particular behaviour of the analyst, but a general principle describing the essence of the psychoanalytic cure. In the opinion of the author, abandoning this principle may have detrimental consequences both theoretically and technically. Finally, the author discusses the emotional presence of the analyst in the analytic setting and suggests an updated version of the idea of analytic abstinence.     

A view from the visitors' gallery

SUMMARY

In this paper, the author describes aspects of his work as a psychoanalytical psychotherapist in a hospital for diseases of the colon and rectum. After reviewing some of the earlier psychoanalytic literature (Freud and Abraham), and more recent theoretical contributions, two cases are described in some detail, which help give a flavour to some of the work. The paper concludes with caveats about the internal and external working environment, which will facilitate or hinder working in particular medical settings.     

Does anything go? Towards a framework for the more transparent assessment of psychoanalytic competence1

It has been difficult to know what does and does not constitute competent psychoanalytic work and so equally difficult to assess when it is being practised and when it is not. This makes difficult any form of disciplined evaluation of the outcome of training, which has a series of problematic outcomes for psychoanalytic practice, psychoanalytic institutions and the relationship to allied disciplines and professions. In this paper, the author considers how far it might be possible to devise a framework for assessment of training programmes within a disciplined psychoanalytic pluralism. The aspiration is to develop a transparent framework, based on an empirically supported demonstration of analytic capacity. The framework needs to be sensitive and subtle, and to be able to withstand challenge. It needs to take cognisance of the twin facts that there is more than one way to practise psychoanalysis and that it is necessary to avoid ‘anything goes’. Drawing on an ongoing project undertaken by European IPA institutes, the author describes some of the problems colleagues have been experiencing in European institutes, because they have not had available transparent criteria for assessment. He outlines a preliminary form of a proposed method for making more transparent and supportable assessment. The author intends for this paper to inspire hope, enquiry and debate.     

Miscarriages of psychoanalytic treatment with suicidal patients2

The author describes a particularly perilous frontier on the psychoanalytic landscape‐ namely, the treatment of suicidal patients with serious personality disorders. Using a clinical example of egregious boundary violations by an analyst, he describes specific countertransference pitfalls that lead to mishandling the patients' expressions of suicidal despair. These include disidentification with the aggressor, failure of mentalization, collapse of the analytic play space, reactions to loss in the analyst's personal life, omnipotence, envy of the patient and masochistic surrender. The author emphasizes the unique vulnerabilities that accompany analytic treatment of such patients.     

Psychoanalysis and University in Brazil: Possibilities and Limits of This Articulation

The goal of this article is to clarify some of the aspects concerning the academic teaching and research that is carried out in the field of psychoanalysis in the Brazilian Universities, versus the transmission and training in psychoanalytic institutions. The author describes how psychoanalysis is present in the Brazilian university context, from undergraduate to graduate studies, and also points out perspectives regarding the future of psychoanalysis in Brazil.     

Anna Freud: The Hampstead War Nurseries and the role of the direct observation of children for psychoanalysis

The psychoanalytic tradition of direct observation of children has a long history, going back to the early 20th century, when psychoanalysis and the emerging field of 'child studies' came into fruitful contact in Freud's Vienna. As a leading figure in the attempted integration of direct observation with the new psychoanalytic knowledge emerging from the consulting room, Anna Freud played a crucial role in the emergence of this field. But her major contribution to the theory and practice of observing children came during the Second World War, when she founded the Hampstead War Nurseries. The author describes in detail this important period of Anna Freud's career, and discusses the impact it had on later work. He explores the theoretical contribution that Anna Freud made in the post-war years to the debate about the place of direct observation in psychoanalysis, and concludes that Anna Freud's 'double approach' (direct observation plus analytic reconstruction) still has a great deal to offer as a method of both psychoanalytic research and education.     

Social Work,Psychoanalysis, and Smoke-Filled Rooms

Abstract

This paper describes one social worker's journey from the first days of his social work education to his current experience as a psychoanalyst, and the subsequent transformation of his professional self. The complementary nature of the relationship between social work and psychoanalysis is considered. Through a personal vignette, the author hopes to remind current social work educators about the usefulness of psychoanalytic theory and practice within the context of casework values and principles.     

The Moses

In this essay, the author engages the Moses, a sculpture by Michelangelo, as a transformational object. He does so in light of psychoanalytic interpretations of the statue, including Sigmund Freud’s (who referred to his essay on the Moses as “a joke”), as well as three psychoanalytic interpretations after Freud. While drawing on and combining features of all of these psychoanalytic interpretations, the author makes particular use of Moshe Halevi Spero’s interpretation to affirm a reading of the Moses as representing a paternal figure who not only gives up his anger (and power to castrate) but also actively nourishes his children like a nursing mother. The author also understands Freud’s essay on the Moses to be a form of teasing, which, in part, is why it has been a transformational object for him.

     

SEEKING COMFORT IN AN UNCOMFORTABLE CHAIR

The author explores the concept of comfort in relation to the setting. The concept of comfort, an unusual word in the psychoanalytic lexicon, describes the intuitive and complex experience of patient and analyst being together in the analytic office. The couch and the chair are not the only tools of the setting, but they are potential instruments with which to study the therapeutic process, both in high‐frequency therapy and in lower‐frequency treatments. To describe the transformations that an alternative experience of comfort can promote, the author looks at the intersection of this concept with the body–mind relationship and with the Bionian concept of binocular vision.     

Love Never Ends Well: Termination as the Fate of an Illusion: Commentary on Papers by Jill Salberg and Sue Grand

The following is a discussion of the papers by Jill Salberg and Sue Grand on the topic of psychoanalytic termination. The discussion focuses on the idiosyncratic nature of the psychoanalytic relationship and the particular nature of its ending, some similarities between the end of analytic love and the loss of love in every day life, problems with analyst initiated terminations, and the transgressive nature of termination and analytic creativity. There is a discussion of the cases presented by each of the authors.