Mental Health and Mental Disorder: A Sociological Approach,edited by Arnold M. Rose

This paper presents a model of group analysis based on Aristotle's causal notions. Aristotle's concept of man as a social animal provides a philosophical rationale for an interpersonal treatment forum. His causal theory supplies an encompassing atheoretical model for examining, understanding, and changing “things which have in themselves the source of their changing or staying unchanged.”

Attention to the four causal foci is suggested as the basis for a full-ranging group analysis. Material cause examines: “what” makes a thing what it is. Efficient cause investigates “how” various behaviors and emotions are set in motion. Final cause searches out “where” behavior is aimed. Formal cause traces “why” behaviors take particular forms.

It is suggested that a “cause for pause,” in the ongoing group process, is the emergence of a powerful and specifiable trend, whether a transference, poignant interaction, or groupwide conflict. The “pause to cause” is examined in detail, as each causal foci is elaborated. A sequential analysis moving from “what > how > where > why” is suggested at three levels of possible intervention: individual, interpersonal, and group as a whole. In conclusion, the timing, advantages, and restrictions of such a causal approach are considered.     

Brief mother–infant treatment: Psychoanalytically informed video feedback

Specific patterns of interactive regulation documented by microanalytic methods of infant research can be applied to clinical interventions with mothers and infants. A brief treatment model is described that includes face‐to‐face split‐screen videotaping (one camera on each partner) and therapeutic observation of the videotape with the parent. The intervention uses “video feedback” informed by a psychoanalytic approach, including positive reinforcement, modeling, and information giving, as well as interpretation, while watching the videotape. Specific interactions in the areas of attention, arousal, affect, and timing regulation are evaluated. The psychoanalytic intervention links the “story” of the presenting complaints, the “story” seen in the videotape, and the “story” of the parent's own upbringing. An attempt is made to identify specific representations of the baby that may interfere with the parents's ability to observe and process the nonverbal interaction. The mother's powerful experience of watching herself and her baby interact, and our joint attempts to translate the action‐sequences into words, facilitates the mother's ability to “see” and to “remember,” stimulating a rapid integration of the mother's procedural and declarative modes of information‐processing. One treatment case, involving six contacts, is presented to illustrate the approach. By applying the specificity of interactive regulation identified by microanalysis of videotape into the psychodynamic treatment of mother–infant pairs, basic research can be translated into clinical practice. ©2003 Michigan Association for Infant Mental Health.     

不只是“谈话疗法”：精神分析治疗中的非言语维度

精神分析治疗在很长一段时间里被视为“谈话疗法”,其治愈机制是将潜意识的内容意识化,语言解释在其中发挥关键作用。自20世纪末开始,越来越多分析师强调非言语交流在治疗中的作用。非言语交流不仅能够为咨访双方提供更丰富的交流形式,还能通过互动中的“相遇时刻”,实现对患者过去经验的重组,改变其有缺陷的内隐关系知晓。非言语交流和语言交流能够在治疗中发挥互补作用,未来的精神分析心理学要继续加强对非言语领域的研究。     

不只是“谈话疗法”：精神分析治疗中的非言语维度

精神分析治疗在很长一段时间里被视为“谈话疗法”,其治愈机制是将潜意识的内容意识化,语言解释在其中发挥关键作用。自20世纪末开始,越来越多分析师强调非言语交流在治疗中的作用。非言语交流不仅能够为咨访双方提供更丰富的交流形式,还能通过互动中的“相遇时刻”,实现对患者过去经验的重组,改变其有缺陷的内隐关系知晓。非言语交流和语言交流能够在治疗中发挥互补作用,未来的精神分析心理学要继续加强对非言语领域的研究。     

“Crunches,” “(K)nots,” and Double Binds—When What Isn't Happening Is the Most Important Thing: Commentary on Paper by Barbara Pizer

This discussion compares Pizer's concept of “relational (k)nots” with “crunches” and double bind impasses. It argues that all of these constructs capture what happens when conventional analytic method—the exploration, elucidation, and interpretation of transference—fails to work. In this context a “last-ditch effort” emerges, a necessary crisis of treatment. The situation is a plea that something must occur “now or never” or the “charade of therapy is over.” This plea is extraordinarily challenging since it embodies contradictory elements wherein the patient's very call for involvement with the analyst is embedded in a process that obfuscates their connection. Notably this sets the stage for the “damned if one ‘gets it’ and damned if one doesn't” experience that is a part of the paradox of recognition/mis-recognition that befuddles many analyses.

Extrication from such impasses requires the analyst's recognition that she is colluding in a kind of avoidance or distraction from recognizing their disconnection. Her second act involves meta-communication about their process. That is how their “relational knot” both binds them together while negating their connection. While this observation may be necessary it is recognized as insufficient on its own. Thus her third move out of the impasse requires her to enter into a state of improvisation. That is, to use some part of herself that must surrender from the one-up one-down impasse position of “either your version of reality or mine.” Instead, she must cultivate through her action a third way in which both she and her patient can think about their impasse and do something about it, including something different from what either one might have imagined before.     

Collusive induction in perverse relating: Perverse enactments and bastions as a camouflage for death anxiety

The author argues that one of the main functions of perverse relatedness is to induce the analyst into becoming the patient's unconscious accomplice in a “perverse pact” against the analytic work aimed at disavowing intolerable aspects of reality. The intense power of collusive induction in perverse relating leads the analyst to participate in transference‐countertransference enactments and to the crystallization of a silent and chronic unconscious collusion between the patient and analyst in the analytic field, stagnating the process (bastion; Baranger and Baranger). The author claims that analysis of perverse pathology should not be limited to interpretation of the patient's intrapsychic functioning but should also focus on the information obtained by the analyst through his participation in collusive enactments; the analyst should also take a “second look” at the analytic “field” to detect underlying bastions. The author reviews the main psychoanalytic contributions that have clarified the phenomenon of collusive induction in perverse relating and as an illustration, describes the analysis of a man with a perverse character; in this patient, one of the main functions of his perverse relatedness was to induce the analyst to become an accomplice in his disavowal of his terror of death. The author highlights the influence of death anxiety in the bastions that develop in the treatment of perverse patients.     

“There Was a Child Went Forth” Commentary on Paper by Steven Stern

In this discussion of Stern's rich and thoughtful contribution to the dialogue between unified- and multiple-self theories, I refer to his earlier conceptualization of repeated and needed relationships. I thus highlight how his current model strikes me as shifting his emphasis toward identificatory factors, both in development and in clinical process, and away from the working through, or negotiation of, repetitions of relational configurations. Through Stern's clinical examples, I engage dialogue about how his construct of an “intersubjective self” relates to the qualities of multiplicity he accounts for in his theory. And I consider the implications for clinical technique of favoring identificatory influences over the analyst's living through the experience of transference repetitions with the patient and thereby introducing ameliorating responses from within, rather than from a stance more external to, embeddedness in transference–countertransference repetitions.     

Interior experience within analytic process

In this paper, I consider the feeling of interiority as it evolves within the treatment relationship. A capacity to access and sustain one's interiority reflects a sense of personal solidity within which the validity of subjective process and privacy is taken for granted. When this capacity is relatively undeveloped, individuals rely on the “other”; (including the analyst) to help them contact, elaborate, or manage their affective experience. Quite paradoxically, the analyst's active investigation of dynamic or intersubjective process may obfuscate rather than clarify this core difficulty. I suggest two alternative approaches to the treatment situation that stand in some tension and yet also complement each other. One emphasizes the “active”; investigation of dynamic and dyadic process, wherein the analyst works interpretively and/or around relational issues. The other is organized around the “interior”; dimension of the treatment experience, emphasizing the patient's need to develop or manage her affective process in the relative absence of input from the analyst. Two clinical situations are described, the first illustrating the use of silence with a patient whose difficulties involved affect articulation, and the second involving a patient whose need for affect regulation made her highly dependent on the analyst for soothing.     

Being “Done For” in Analysis: Commentary on Paper by Stuart A. Pizer

Stuart A. Pizer's fascinating article explores through a relational lens analytic impasse, and its manifestation through transference and countertransference love. How this love is demonstrated (or not) and the ways in which we provide for our patients will have profound effect on the process (and progress) of any treatment. But, too often, reluctance to “do for” our patients compromises our ability to provide what may be needed in any given moment. Perhaps an expansion of the “doer—done to” dyadic paradigm into a “doer—done for” model might allow more analytic leeway and more possibility of growth within our patients.     

Private Terrors Sexualized Aggression and a Psychoanalyst's Fear of Her Patient

This clinical paper explores the meanings and evolution of an analyst's reaction of fear in relation to her patient's sexualized aggression. From both an intrapsychic and an intersubjective perspective, the author analyzes the coconstruction of this transference—countertransference phenomenon. Case vignettes illustrate the author's attempts to address her patient's sexualized aggression while struggling to free herself from the feelings of intimidation and fearfulness stirred by his sadomasochistic fantasies and patterns of interaction. The analyst's unconscious identification with the patient's disowned femininity and narcissistic vulnerability is seen as central to this countertransference “stranglehold.” Release from the analyst's masochistic position comes through a shift in her own affective participation. The importance of the analyst's recognizing her own unconscious contributions to this sadomasochistic dynamic is emphasized and elaborated. Discussion also focuses on the relevance of gender to the issue of countertransference fear, as illustrated in this particular male patient—female analyst dyad.     

Phallic Integration and Male Identity Development

The analytic setting as well as the analyst's initial communications unavoidably exert influence that may be perceived by the patient as a sexually tinged intrusion, which evokes questions about what the analyst wants. Together with the asymmetry of the analytic relationship, these phenomena uncannily bring to life a repressed relationship between infant and adult in which analogous stimuli constitute enigmas for the child. The theoretical understanding of Jean Laplanche of such enigmatic transference in terms of “primal seduction” is reviewed and clinical material is provided to illustrate Laplanche's ideas. The discussion addresses “recentralized” and “decentralized” aspects of sexuality. Primal seduction is discussed as including not only intrusion, but also qualities of stimulation and trust.     

Self psychology and projective identification—whither shall they meet? a reply to the editors (1995)

The concept of projective identification continues to be viewed as alien, even dangerous, by self psychologists. Six aspects of self‐psychology/intersubjectivity theory are explored in an attempt to understand the presumed incompatibility of self psychology and projective identification: 1) the empathic vantage point; 2) the focus on subjective reality; 3) the emphasis on the analyst's personal contribution; 4) the focus on selfobject experience; 5) the disruption—restoration process; and 6) the defining of transference and countertransference as “organizing activity.”; The self‐psychological/intersubjective concepts that come closest to describing the phenomenon of projective identification—that is, empathic immersion, affect resonance, and reciprocal mutual influence—fail to capture at least three of its essential elements 1) the patient's persistent, unconscious intent to communicate certain unformulated aspects of self through the other; 2) the analyst's sense of being “taken over”; by the patient's experience; and 3) the intensely visceral quality of the analyst's experience. It is argued that self psychology ignores this important form of patient communication to its own detriment and that the concept of projective identification needs to be reformulated in terms that are more experience near to self psychologists. It is suggested that there exists a normal, developmental need, a selfobject need, to communicate intolerable, unsymbolized affective experience through the other's experience—a need that remains more pervasive and intense in some of us than in others—and that the longed‐for selfobject response is to have one's communication received, contained, and given back in such a way that one knows the other has “gotten”; it from the inside out.     

Time-Soaked: How Trauma Submerges In and Out of Time

This clinical presentation explores how we are submerged in time as patients and analysts, particularly when intergenerational traumas are present. The temporal dimension of this submerged time may involve an engulfing past that is heavy with destructiveness. This paper examines how a patient and analyst emerge from such a past. I suggest a patient may begin to feel a sense of “self in time” (Seligman, 2016) when a foundation for mutual recognition is established through implicit gestures and nonverbal interactions. Once this level of interaction becomes enlivened, time may begin as well as the process of becoming a self with an other.     

Transference,triangles and trajectories

In this article the author addresses the issue of the need to lessen the likelihood of a regressive transference neurosis in short-term therapy. He examines the role that active interpretation of the transference can have in shaping the transference so that it remains at the level of the transference that is ubiquitous. He explores the relationship between such an active interpretative approach and the need for the therapist to be empathic and sensitive to the patient and to allow space for a patient's independent discoveries. The author describes the role of the Central Therapeutic Focus, as a constellation of the Triangles of Insight, in guiding the therapist to select those manifestations of the transference to interpret, and in enabling the therapist to retain a stance that is sensitive and empathic. The Central Therapeutic Focus is contrasted with the concept of the Central Issue, and with the latter's more specific attention to the contribution that it makes to the therapist's communication of their empathic understanding of the patient's difficulties. The nature of the relationship between the therapist and the patient in short-term therapy is explored further and the connections between companionable interaction, ego-relatedness and the matrix of the transference are outlined. The author proceeds to consider the nature of the process of working through in short-term therapy and of the need to attend to the patient's external world as the place in which this can occur. The contribution of the Central Therapeutic Focus in shaping the trajectory through which the patient and therapist attend to the external world is examined. This in turn is linked to the identification of a patient's ordinary solution to their problem as a means of resolving their Dilemma. The article concludes with a case example that illustrates these themes.     

Analytic change: Assessing ways of being in a psychoanalytic follow‐up interview

The article argues that the concepts of relational scenario, structuralized affect and actualized affect are proposed candidates for observation of changes in relational ways of being as it is expressed in transference. A psychoanalytic follow‐up interview of a former analytic patient is presented in order to illustrate how change in relational ways of being may be registered and studied. By triangulating the patient's verbal report of change with nonverbal information and transference–countertransference dynamics, one may grasp qualitative changes in relational ways of being. The case presented illustrates a former patient's on‐going process of working towards representing aggression in a more direct manner and how this process is made observable with the aid of the proposed concepts in the interview situation. The proposed concepts of relational scenario, structuralized and actualized affect discussed are compared to the concept of transference used in studies of core conflictual relationship theme (CCRT).     

Transferences in parent–infant psychoanalytic treatments

In parent–infant treatments, babies sometimes exhibit symptoms such as screaming, clinging, and fearful gaze avoidance of the analyst. The paper investigates if such phenomena may be regarded as transference manifestations, and if so, if they appear both in younger and older infants. Based on three case presentations, it is concluded that some babies are capable of forming both brief and enduring transferences. The term “indirect infant transference” refers to when a baby reacts emotionally to the analyst as long as the parent's transference remains unresolved. “Direct transference” refers to when a baby reacts in a non‐mediated way to the analyst. The necessary tool of investigation for discovering these phenomena is a psychoanalytic method with an explicit, though not exclusive, focus on the baby. Discerning them in the clinical encounter may help us understand the baby's predicament and when and how to address the baby or the parent. These treatments constitute an empirical field awaiting more extensive clinical and theoretical investigation. Already now, they suggest that transference may be rooted in, and may appear during, very early developmental stages. The paper's positions are compared with those put forward by other parent‐infant clinicians.     

Sustained Empathic Focus and the Creation of a “We Space” Revisited in the Light of Recent Findings in Neurobiology

This article is an attempt to expand our understanding of the curative process with an emphasis on the group therapy setting. It presents a self psychological approach that underlines the importance of a “sustained empathic focus” on each patient’s subjective experience and the creation of what we have referred to as shared “vulnerable moments” and a “we-space.” The relationship of our approach to recent findings in the field of neurobiology is then considered.     

A Self Psychologist in Couplesland: Multisubjective Approach to Transference and Countertransference-Like Phenomena in Marital Relationships

This essay introduces the reader to some basic self psychological concepts that have useful applications to couples therapy. Two points are highlighted. First, the therapist must be constantly aware of the narcissistic vulnerability of each of the participants. Second, the working through of transference and countertransference-like experiences within the marital dyad is just as central to an understanding of the curative process in couples treatment as it is within the patient/therapist dyad in individual treatment.     

The Child Thought Long Dead Sings through Dylan Thomas in “Poem in October”

Was Dylan Thomas's reunion with the child he had been—the child he had thought long dead who sings through him in “Poem in October”—the catalyst of a former student's recovery from depression? Inspiring this question is this student who had suffered recurring autumnal depression, who shared with Thomas a birthday in October, and who claimed sustained recovery in late November after having studied this poem with his peers in October—a claim supported by his remarkably animated glow, without regressions in subsequent years. In other words, had the student identified with the poem's epiphany—the poet's mysterious reunion with the child he had been and the amazing rebirth of the child's voice from whispering to singing through him—what Jung called the “gift of love”? In response, this study examines the poem's epiphany and its effects upon Thomas's creative vision relative to what Stephen Rojcewicz finds so vital to self-transformation: the created metaphor, translation, transport, and transference that not only evoke the presence of divinity in nature, but also, according to C. G. Jung, participate in a divine creative process. The study concludes with a tentative “yes” to the question, a “yes” resonant with the student's claim in early December, “I have never felt so creative!”