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.     

Unplanned pregnancies and abortion counselling: Some thoughts on unconscious motivations

Abstract

My experience of abortion counselling¹ over ten years has shown me the importance of understanding the unconscious dynamics behind an unplanned and unwanted pregnancy. Unless these dynamics are made conscious and understood, the experience of abortion may have to be repeated again and again. Both becoming pregnant and having an abortion often involve unconscious conflicts and fantasies originating in a woman's early development and reflecting her relationship with her mother. These may be acted out via an unplanned pregnancy and decision to have an abortion. The central task of abortion counselling is to address and make links with the unconscious processes, and in particular help the pregnant woman recognize and acknowledge her ambivalent feelings. In this way the counselling makes use of the opportunity to reflect provided by the crisis situation of the pregnancy.     

The Castration Complex

ABSTRACT

Theoretical formulations of the castration complex have changed as psychoanalytic theory has developed. The author briefly reviews the literature and asserts that analyzing the set of fantasies related to potential or imagined castration continues to be clinically quite important. Understanding these unconscious fantasies provides a window into the individual's experience of his or her body in relation to those of important others throughout development. A case is provided to illustrate this, and to discuss the ways in which several different ways of thinking about castration fantasies contributed something essential to this analysis.     

A PSYCHOANALYTIC READING OF PETER HØEG'S NOVEL MISS SMILLA'S FEELING FOR SNOW3

The author presents a psychoanalytic reading of the Danish author Peter Høeg's masterpiece ‘Miss Smilla's Feeling for Snow’, focusing on the special linguistic style of the novel. Further, the author puts forward an interpretation of the heroine, seeing her as a literary example of female bisexuality. Investigating the heroine's fate, the author discusses Miss Smilla's phallic defence and identity. The narrative technique in Høeg's novel is analysed through Lacan's concepts of the Real, the Imaginary and the Symbolic. The main figure is interpreted as an imaginary example of female bisexuality. Miss Smilla has neither an unambiguous gender identity nor ethnicity. The heroine is pictured in a conflict between two cultures: the Greenlandish and the western European, and her bisexuality both reflects this and is part of it. The author proposes to interpret a significant memory from Smilla's early childhood as an example of a castration phantasy, which retroactively gives new significance to the little girl's pre‐oedipal frustration.     

The countertransference dream1

Can the analyst's night‐dream about his patient be considered as a manifestation of countertransference‐and, if so, under what conditions? In what way can such a dream represent more than just the disguised fulfillment of a repressed wish of the analyst? Is there not a risk of the analyst unconsciously taking up and ‘using’ the content of a session or other elements coming from the analytic situation for his own psychic reasons? The author, closely following Freud's dream theory, shows the mechanisms which can allow us to use the dream content in the analytical situation: preserved from the secondary processes of conscious thinking, other fantasies and affects than in the waking state can emerge in dream thought, following an ‘unconscious perception’. After examining the countertransference elements of Freud's dream, ‘Irma's injection’, which leads off The interpretation of dreams, the author presents a dream of her own about a patient and its value for understanding affects and representations which had hitherto remained unrepresented.     

Affective Honesty and Compassion Come in Many Forms: Discussion of “Love (and Hate) With the Proper Stranger: Affective Honesty and Enactment,” By Holly Levenkron,L.I.C.S.W.

Holly Levenkron's work with her patient, Ali, beautifully illustrates one way that a creative analyst makes superb use of her own experience to communicate and negotiate with great affective honesty. Holly's analytic style emphasizes the effective use of a particular kind of self-disclosure and a way of thinking about intersubjectivity and enactment associated with the contemporary Relational movement. Yet, it may be Holly's personal willingness to allow the analytic relationship to profoundly destabilize and influence her that most engages Ali in their work.

An imaginary analytic scenario is described with an analyst, Dr. X, who like Holly is destabilized by Ali but whose thinking about intersubjectivity and enactment emphasizes an empathic immersion in Ali's experience of the analytic relationship. In contrast to Holly, Dr. X focuses primarily on grasping and interpreting the adaptive strivings that animate Ali's differently organized subjective world.

The underlying capacity to acknowledge and use the analyst's own version of the patient's issues may also characterize analyses such as that of the hypothetical Dr. X—in style that are more explicitly “interpretive” (less confrontative) than Holly's work. These two contrasting approaches highlight the wide range of ways to think about intersubjectivity, enactment, and affective honesty in the analytic process.     

What’s So Great About Authenticity Anyway? The Therapeutic Function of an Analyst’s Lie

How can we understand moments when the analyst lies to her patient? When it’s not the patient’s lying at issue but the analyst’s? When we suddenly find ourselves being deliberately disingenuous in the analytic hour? When our commitment to authenticity conflicts with the patient's need to create and sustain certain fantasies about us? Psychoanalytic literature typically focuses on the dynamics of the patient’s lie but rarely is the analyst's authenticity questioned. Are there times when the analyst might choose to lie in order to preserve herself, as well as, the relational bond? The complexity of this “choice” is explored and the erosion of an analyst’s authenticity unpacked during the final days of a difficult treatment.     

The Black Man and the Mermaid: Desire and Disruption in the Analytic Relationship

This paper considers the impact of desexualization of the maternal on the development of female sexuality. A “chance encounter” revealing a desire in the female analyst, previously unsuspected, disrupts a female patient's prior sense of homoerotic immersion with the analyst. I argue that a girl's would-be oedipal competition is encased within a patriarchal structuring of sexuality where the mother is rendered solely reproductive and preoedipal, not erotically sexual. I examine the meanings for a patient of internalizing a female figure, her analyst, who is viewed as both maternal and sexual. I suggest that a female sense of genital inadequacy and inferiority may have a component of not being able to link the mother's (and in the transference, the analyst's) use of her genitals with her use of her mind/maternal function. I unfold a thesis regarding maternal desexualization that I believe, given mother–infant symbiosis, has rather extensive applicability, and that can lead to viewing any third party as a “dark” interloper.     

The role of the analyst in the analytic cure during times of chronic crises

The role of the analyst in psychoanalytic treatment during periods of chronic crises is illustrated with material from two case studies. The first clinical vignette shows an analyst able to stay with fears evoked in the patient by the traumatic external reality, even as the analyst tried to explore with the patient an inner universe that handled this reality in unique ways. The second case study focuses on how the analyst's countertransference during this period of chronic crises, which she was experiencing along with the patient, made it difficult for her to contain the patient's fears and anxieties, because of the threat to her own existence, as well as to her identity as an analyst. In this second case the analyst, out of denial of the external situation, focused blindly on the patient's internal reality in order to counteract her own sense of passivity and helplessness in the confrontation with death and destruction. She clung to "classical" analysis by trying to analyze the patient's defenses, work them through, etc., thus making so-called analytic interpretations rather than staying with the patient's fear, as well as her own, and helping the patient more directly. A turning point came with the birth of the analyst's granddaughter; fear for the new arrival's safety made the analyst sharply aware that it is impossible to ignore external reality, that it must be given a place both in everyday life and in analysis. This awareness enabled the analyst to contain the patients' fears, which helped him feel more supported and facilitated change.     

A case of premenstrual distress: bisexual determinants of a woman's fantasy of damage to her genital.

Case material is used to illustrate specific clinical application of the concept of primary femininity. Some contemporary contributions to the psychoanalytic theory of female psychosexual development are presented as complementary with, rather than contradictory to, more familiar, longstanding formulations that emphasize phallic strivings in women. In the clinical example reported, a fantasy of genital damage underlay a woman's premenstrual distress. Aspirations and concerns related to both aspects of her fundamental bisexuality participated in symptom formation and had to be investigated in order to achieve symptom relief. As the analytic work unfolded, it could be seen that the patient's awareness of her feminine aims served to keep her masculine aims out of awareness, and vice versa.     

WHOSE SLEEP IS IT,ANYWAY? OR ‘NIGHT MOVES’3

The analyst's ‘sleep’ during sessions is a puzzling, troubling, extreme experience, which has rarely been described in the psychoanalytic literature. The author presents a clinical illustration in which her recurring ‘sleep’ during the sessions was approached as an open, central issue. She attempts to explore, understand and integrate this experience theoretically and clinically, first by reviewing and examining the psychoanalytic literature on the subject and on related phenomena, and then, more particularly, by formulating her own explanation of it. She emphasises being in the grip of the psychoanalytic process, and the immersed involvement and converging of patient and analyst, which generate a conjoint state of deep experiential interconnectedness and impact on each other ‐ in particular the impact of the patient's inner world on the analyst. In this context, the author also refers to the notions of ‘the uncanny’, ‘fear of breakdown’ and dissociative self‐states and the mitigation of the patient's dissociative self‐experience via the analyst's vicarious dissociative experience.     

MORTALITY,INTEGRITY, AND PSYCHOANALYSIS (WHO ARE YOU TO ME? WHO AM I TO YOU?)

The author narrates her experience of mourning her therapist's sudden death. The profession has neglected implications of the analyst's mortality: what is lost or vulnerable to loss? What is that vulnerability's function? The author's process of mourning included her writing and her becoming an analyst. Both pursuits inspired reflections on mortality in two overlapping senses: bodily (the analyst is mortal and can die) and character (the analyst is mortal and can err). The subject thus expands to include impaired character and ethical violations. Paradoxically, the analyst's human limitations threaten each psychoanalytic situation, but also enable it: human imperfection animates the work. The essay ends with a specific example of integrity.     

Incognito or not? the patient's subjective experience of the analyst's private life

This paper examines the meaning for the patient of the analyst's personal life and personality which are ostensibly banished from the consulting room. The therapist has a not‐always‐so‐secret “secret life”; that the patient is supposed to “not know”; about. Yet, more or less unconscious perceptions, impressions, and fantasies about extratherapeutic aspects of the analyst are omnipresent and significantly color the psychoanalytic enterprise.

Moreover the analyst as a person generally plays a critical and underacknowledged role in the patient's experience of the endeavor. Constructing multiple overlapping images of the analyst and of the analytic relationship, the patient discovers himself or herself in the matrix of these relationships with various images of the analytic other. The analysand is motivated to make sense of the analyst as wholly as possible, the better to place into context the analyst's interventions. The patient's resulting view of the analyst's subjective experience acts as a lens that filters and subtly alters the meaning of the analyst's communications.

I illustrate these points by relating my work with a patient whose dreams uncannily picked up on a (consciously) unknown aspect of my private life—my having a handicapped son. The treatment thereafter centered on the patient's identification with my child (as someone “disabled") and on the meaning of her having dreamt something so personal about her therapist.     

The patient's transference experience of the analyst's gender: Projection,factuality, interpretation,or construction

The constructivist/relational perspective has challenged the analyst's emotional superiority, her omniscience, and her relative removal from the psychoanalytic dialogue. It at first appears to be antithetical to treatment approaches that emphasize the analyst's holding functions. In this essay I examine the holding model and its resolution from a relational perspective. I propose that the current discomfort with the holding function is related to its apparent, but not necessarily real, implications. I discuss the analyst's and patient's subjectivity during periods of holding. I believe that the holding process is essential when the patient has intensely toxic reactions to “knowing”; the analyst and is therefore not yet able to stand a mutual analytic experience. During holding, the patient experiences an illusion of analytictic attunement. This requires that the analyst's dysjunctive subjectivity be contained within the analyst, but not that it be abandoned. Ultimately, it is the transition from the holding position toward collaborative interchange that will allow analyst and patient explicitly to address and ultimately to integrate dependence and mutuality within the psychoanalytic setting and thereby engage in an intersubjective dialogue. The movement toward mutuality will require that the analyst of the holding situation begin to fail in ways that increasingly expose her externality and thus her subjectivity to the patient.     

Phallic and seminal masculinity: A theoretical and clinical confusion

Both inside and outside psychoanalysis, the word, 'seminal', is used to praise a creative contribution to science and culture. Rarely, however, does it refer to male procreativity, to the structures and functions that subserve it or to the anxiety related to a threat to it. This situation becomes evident in the concept of castration anxiety, which typically refers, with Freud, to cutting off the penis and not to extirpating the testicles. This phallic theory has been debated, repudiated and ignored. While there is an alternative literature on non-phallic masculinity, it is scattered and rarely refers to seminal function. Freud's theory meets his requirement for a well-articulated representation of absolute loss as an experience, but this clear structure – and its repudiation – obscure the observation and theory of the internal world of the male. I propose the concepts of 'seminal masculinity' and 'seminal castration', which I ground in Melanie Klein's concept of depressive anxiety. I contrast them with phallic masculinity and phallic castration anxiety, which I ground in her concept of paranoid–schizoid anxiety. I argue that they meet Freud's requirement that castration be a potential experience and that understanding masculinity demands such a basis.     

Patients’ Pregnancies During Treatment: The Influence of the Analyst’s Psychology

Psychoanalytic therapists are today far more aware of countertransference effects, intersubjectivity, and mutual influence. The area that has been explored least in this two-person appreciation of psychoanalytic process is the effect of the psychodynamics of the therapist in a wide sense—that is, how the therapist brings a whole psychology, with a wide array of potential transferences, to each treatment. Triggered by the unexpected announcement of a patient’s expecting a baby, the author reviewed his practice and found that a large portion of his women patients ages 30–45 had become pregnant during therapy or psychoanalysis. The particulars were varied: how much the patient wanted a baby, whether the treatment was psychotherapy or psychoanalysis, the patients’ personality structure. Was the analyst’s psychology a common factor? The paper presents three quite different case examples and examines whether and how the author’s developmental and inner experience of women, sexuality, pregnancy could have contributed to a dyadic process that, in turn, could lead to pregnancy. If such effects happen, then it is important to look beyond and behind “anonymity” and “neutrality,” as well as momentary countertransferences, to the real-life effects that we have in our treatments.     

Discussion of Presentation by Joseph Newirth

Discussing Joseph Newirth's case from a modern Freudian perspective, I explore possible sources of the patient's degraded view of herself, her ambivalent feelings toward men, and her fears of sexuality. I also discuss the course of the treatment, noting that both the patient's progress and the core of her resistance centers on her complex relationship with her analyst. This has been the source of healing and of avoidance of her inner world of imagination and fantasy. I further suggest that active confrontation of the patient's defensive use of her relationship with her analyst would enhance the substantial gains that she has already made.     

'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