On understanding projective identification in the treatment of psychotic states of mind: The publishing cohort of H. Rosenfeld, H. Segal and W. Bion (1946–1957)

A publishing cohort of Kleinian analysts – Rosenfeld, Segal and Bion – implemented Klein's (1946) notions of projective identification and the 'paranoid ' and 'schizoid ' positions in the understanding of a group of psychotic disorders. The author differentiates Klein's (1946) Notes on some schizoid mechanisms paper from its revised version of 1952, maintaining that it was Rosenfeld's clinical work during this period that helped to centralize Klein's redefinition of projective identification. The stage was set for Segal 's contribution in terms of 'symbolic equations,' where the psychotic's attack on the breast left him incarcerated in internal torment and persecution, where things-in-themselves were confused with what they symbolically represented. Segal in turn linked psychotic to normal, paranoid–schizoid to depressive positions, where by means of projective identification and symbolic imagination, the patient could arouse feelings in the analyst related to sadness, guilt and loss. Bion assumed that psychotic pathology reflected disordered thinking, when the severely disturbed used language as a mode of action. The psychotic was profoundly confused between the use of thought and action in the natural world – where thought was required, he preferred action and vice versa. Bion also drew upon projective identification in a new, broader way, so that analysis could now become more of an intersubjective, bi-directional field of projective and communicational influence between patient and analyst. The paper concludes with the impact of the work of Rosenfeld, Segal and Bion and variations on the technique of analyzing psychotic states in terms of the patient's early history, transference and countertransference.     

Affirming 'That's not psycho-analysis!' On the value of the politically incorrect act of attempting to define the limits of our field

This paper is concerned with the value of the act of defining the field of psychoanalysis. It examines the reasons why adopting and especially giving voice to a definition that excludes approaches considered by some analysts to be analytic is commonly regarded as unacceptable within psychoanalytic discourse. It then explains the value and advantages of putting forth exclusive definitions. The author argues that clarifying the pros and cons of such acts of definition contributes to the understanding of the nature of psychoanalysis and the possibility of dialogue between opposing understandings of it. It may also contribute to greater freedom of thought and expression which is essential to the development of psychoanalytic theory and practice.     

On becoming a psychoanalyst

One has the opportunity and responsibility to become an analyst in one's own terms in the course of the years of practice that follow the completion of formal analytic training. The authors discuss their understanding of some of the maturational experiences that have contributed to their becoming analysts in their own terms. They believe that the most important element in the process of their maturation as analysts has been the development of the capacity to make use of what is unique and idiosyncratic to each of them; each, when at his best, conducts himself as an analyst in a way that reflects his own analytic style; his own way of being with, and talking with, his patients; his own form of the practice of psychoanalysis. The types of maturational experiences that the authors examine include situations in which they have learned to listen to themselves speak with their patients and, in so doing, begin to develop a voice of their own; experiences of growth that have occurred in the context of presenting clinical material to a consultant; making self-analytic use of their experience with their patients; creating/discovering themselves as analysts in the experience of analytic writing (with particular attention paid to the maturational experience involved in writing the current paper); and responding to a need to keep changing, to be original in their thinking and behavior as analysts.     

Editorial

This paper discusses contraindications to psychoanalysis and psychoanalytic training. From Freud onwards, there has been a clear understanding that not all patients are helped by psychoanalysis, but there has been considerable controversy as to who might benefit from treatment, and whether this depends on the diagnosis, the personality or the rather vague concept of “analysability". Increasing emphasis has been placed on the analyst-patient relationship and its characteristics, without this clearly solving the dilemma. Moreover, while psychoanalysis was previously perceived rather uniformly in its classical version, treating mainly neurotics, increasing differentiation between psychoanalytic schools has appeared in the last fifty years, which would seem to give grounds for a widening of indications. This development has increased the need for rational criteria for indications and contraindications. In this article, research findings relating to outcome and process and the therapeutic relationship will be examined in parallel with clinical experience. As the therapeutic relationship is probably decisive for the outcome of the treatment, scrutiny of who is suited to be a psychoanalyst should have been an important focus of research. This has not been the case. Available research on this issue and the experiences of practitioners in the evaluation of candidates will be discussed in the following.     

Light and color in a void: The analysis of a special needs child

This clinical report comes from the five year, four day a week analysis of a male child. What is special is that this treatment is of a child with marked mental retardation. I have retained this nomenclature because that is how Ricardo's parents described his mental capacity. What they meant was that he was greatly impaired in his cognition and this could be seen in Ricardo's severe cognitive, social, behavioral, and relational improprieties. I have privileged the function of psychoanalytic understanding and the role of transference to bring about modifications in this child's internal world. And I have considered the patient's psychotic mental state to be in need of psychoanalytic treatment not withstanding his psychosis's connection to his cognitive handicap. I have also added information I have received after the analysis, information that demonstrates continued integration coming from the analytic process. Owing to Ricardo's limited mental capacities, this article advances clinical information that is not often found in analyses of children. There are possibly many other children like him who nonetheless would benefit from dynamic psychoanalytic understanding. On the other hand, I shall not discuss this matter theoretically, even though some theoretic considerations are necessary. Clinical practice and the transferential relation are this report's principal material.     

Psychoanalysis,science, and art: Aesthetics in the making of a psychoanalyst1

This paper critically examines the relationship of psychoanalysis to science and art. Its point of departure is Michael Rustin's theorizing. Specifically, in considering the possibility of a psychoanalyst's having an aesthetic orientation, the author analyses: 1) the difficulty of there being any connection between psychoanalysis and science because science's necessarily presupposed subject‐object dichotomy is incompatible with transference, which, beginning with Freud, is basic to psychoanalysis; 2) the complex relationship between psychoanalysis and aesthetics using Maurice Merleau‐Ponty's philosophical perspective as well as Luigi Pareyson's theory of aesthetics; 3) the Kantian foundations of the psychoanalytic notion of art as the ‘containing form of subjective experience’ 4) intersubjectivity, without which clinical practice would not be possible, especially considering matters of identity, difference, the body, and of sensory experience such as ‘expressive form’; 5) the relationship of psychoanalysis and art, keeping in mind their possible convergence and divergence as well as some psychoanalysts' conceptual commitment to classicism and the need for contact with art in a psychoanalysts's mind set.     

On creating a psychoanalytic mind

The term process knowledge is introduced to highlight a particular way of analyzing that centers on how our patients gain knowledge. It is suggested that analyzing with heightened awareness to process knowledge is crucial for the patients' capacity for self-analysis, and differs from helping patients primarily gain knowledge of their unconscious fantasies and conflicts as the primary curative factor in psychoanalysis.     

“You Just Know It’s the Only Thing You Can Think”: A Conversation with Chodorow

ABSTRACT

Nancy Julia Chodorow (1944–) is a pioneer feminist theorist who brought together academic fields of sociology, anthropology, and psychoanalysis in her work related to feminist theories and psychoanalysis. Her first book, The Reproduction of Mothering: Psychoanalysis and the Sociology of Gender (1978 Chodorow, N. J. (1978; second ed. 1999). The reproduction of mothering: Psychoanalysis and the sociology of gender. Berkeley: University of California Press. [Google Scholar]), gave primacy to a more generalized account of the developmental and familial origins of prevalent psychological differences between femininity and masculinity from a psychoanalytic sociological viewpoint. Her later books, Femininities, Masculinities, Sexualities: Freud and Beyond (1994 Chodorow, N. J. (1994). Femininities, masculinities, sexualities: Freud and beyond. Lexington, KY: University Press of Kentucky. [Google Scholar]), The Power of Feelings: Personal Meaning in Psychoanalysis, Gender, and Culture (1999 Chodorow, N. J. (1999). The power of feelings: Personal meaning in psychoanalysis, gender, and culture. New Haven, CT: Yale University Press. [Google Scholar]), and Individualizing Gender and Sexuality: Theory and Practice (2012 Chodorow, N. J. (2012). Individualizing gender and sexuality: Theory and practice. New York and London: Routledge.[Crossref] , [Google Scholar]), bring in a rich interplay among socio-structural influences (i.e., culture) as well as intra- and inter-psychic dynamic processes, emphasizing more the importance of individuality and subjectivity. Based on an interview I had with Chodorow on the development of her thought, this paper gives Chodorow’s account of her personal history and academic background, current manifestations in feminist social science research and feminist psychoanalysis based on her contribution and legacy, and reflective narratives on the unfolding of feminist and psychoanalytic theories from the 1970s onward. Chodorow’s note to the next generation of feminist psychotherapists is also included.     

Sexuality and Death (Discussion)

Abstract

The case is presented to show how the fear of death, triggered off by sexuality, is related to the fear of castration. Instead the discussant develops the hypothesis that the fear of death depends on a shift of deep regression towards a primary identification with the figure of the dead father.     

The role of the patient's remembered history and unconscious past in the evolution of Betty Joseph's 'Here and now' clinical technique (1959-1989)

The author historicizes one aspect of Betty Joseph's ongoing technical contributions in terms of its originating London kleinian context. Early on she drew upon both the patient's remembered history and unconscious past, linking these experiences in past-to-present transference interpretations in order to effect psychic change. In evolving the technique of 'here and now' analysis, Joseph came to emphasize a communicative definition of projective and introjective identification as well as the significance of enactments while marginalizing the use of part-object anatomical interpretative language. She gradually set aside directly linking the patient's past with the present, compelled now by making direct contact with her patients. She now tracked how difficult patients acted in and responded to interpretations from moment to moment. The author maintains that the explicit and implicit conceptual work of Wilfred Bion as well as Joseph's continuous group workshop for analysts led to an increased understanding of the patient's projective impact on the analyst's countertransference responses, and thereby increased the analyst's capacity with 'difficult to treat' narcissistic spectrum patients described by her colleague, Herbert Rosenfeld. In recent work, while Joseph continues to elucidate what patients recall about their early past, she formats her understanding in terms of a direct analysis of the structure of the patient's projected internal object relations in the transference. The analyst works with the patient's communications and enactments, with a greater emphasis on a more 'inside-to-outside' understanding of transference in contrast to the earlier 'past-to-present' work associated with both Freud and Klein. This investigation concludes with one example of Betty Joseph's significant impact on contemporary kleinian technique by taking up some of Michael Feldman's work. Now the analyst listens to the 'past presented,' the patient's projected internal world, as well as tracks how the patient hears and subtly mishears interpretations for defensive, equilibrium-maintaining purposes, as the analyst attempts to effect psychic change by widening the ego's perceiving functions.     

A successful trial utilizing the Leuzinger-Bohleber methodology for evaluation of psychoanalytic treatment: Preliminary report

Utilizing audio-recorded psychoanalytic interviews of both patients and their analysts, group discussions of these interviews, and the application of questionnaires commonly used in psychotherapy research, the authors investigate the potential use of the Leuzinger-Bohleber methodology as an objective evaluative instrument to assess the quality of psychoanalytic treatment. Preliminary study results were obtained through interviews conducted with seven analysts and their respective patients, three of whom were treated with psychoanalysis (three or more sessions per week, for a duration of no less than one year) and four with psychotherapy (one or two sessions per week, for a duration of no less than one year). Patients were found to be eager to participate, and no adverse experiences were reported by analysts, patients or the research team. In addition to the interviews, further data were obtained through review of mailed-in questionnaires completed by 21 patients. The authors present both preliminary observations regarding the methodology as a whole, as well as the detailed results of one specifi c case subject treated with psychotherapy. Review of study fi ndings supports the utilization of this methodology as an evaluative instrument which may ultimately advance current knowledge of the process and outcome of psychoanalytic treatment.     

Elasticity of Technique: The Psychoanalytic Project and the Trajectory of Ferenczi's Life

The object of this paper is the Elasticity of Psychoanalytic Technique in the work of Sándor Ferenczi. The author sustains that this can be considered neither as an ultimate arrival point nor as a particular stage of Ferenczi's clinical–theoretical body of work, but rather as an ensemble of affective qualities, attitudes and values, which he gradually developed through experience, signalling a paradigm shift in the history of psychoanalysis. The following areas will be explored: the new sensitivity demonstrated by Ferenczi concerning the relational and communicative factors present in the analytic session, his subtle and acute attention to the participation of the analyst's own subjectivity in the therapeutic process, and how these enduring elements of Ferenczi's technique anticipate several significant future developments in psychoanalysis.     

Should supportive measures and relational variables be considered a part of psychoanalytic technique? Some empirical considerations

This article presents some quantitative findings from a survey of 89 psychoanalysts (all members of the American Psychoanalytic Association or the International Psychoanalytical Association) about their own experiences in analysis. A comprehensive questionnaire was used to collect retrospective data about (1) how participants felt they benefited from their analyses and (2) how they remembered their analysts’ technique, personality, and style of relating. A correlational analysis found that, according to our participants’ ratings, the most beneficial analyses were associated with having a caring and emotionally engaged analyst who possessed positive relational and personality qualities, used supportive techniques in addition to classical techniques, and pursued therapeutic as well as analytic goals. Outcomes rated as successful were also associated with experiencing a good ‘fit’, a good working relationship, and a positive therapeutic alliance. Our results support the call for an expanded view of acceptable analytic technique (e.g. Schacter and Kächele, 2007) .     

Reflections on Klein's radical notion of phantasy and its implications for analytic practice

Analysts may incorporate many of Melanie Klein's important contributions (e.g., on preoedipal dynamics, envy, and projective identification) without transforming their basic analytic approach. In this paper I argue that adopting the Kleinian notion of unconscious phantasy is transformative. While it is grounded in Freud's thinking and draws out something essential to his work, this notion of phantasy introduces a radical change that defines Kleinian thinking and practice and significantly impacts the analyst's basic clinical approach. This impact and its technical implications in the analytic situation are illustrated and discussed.     

Between Wonder and Doubt: Psychoanalysis in the Goal-Free Zone

This paper examines the experiential dimensions of wonder and doubt as one way to articulate the creative and growth-promoting tensions between the medical/scientific model and the spiritual/mystical model. Both forms of experience, it is argued, function as necessary elements in a psychotherapy that integrates psychoanalysis and spiritual praxes. Fundamental differences between the medical/scientific model and the spiritual/mystical models are examined. The notion of the gap serves to illustrate these diametrically opposed, albeit compatible and necessary, points of view. The multifaceted layers of movement between Buddhism and psychoanalysis typify interacting dynamics between the two disciplines and provide a focal point for discussion. The paper then explores parallels between the Zen Buddhist notion of Satori as explicated in the writings of D. T. Suzuki and Wilfred Bion's notion of O. Theoretical aspects of the discussion provide a backdrop for exploring clinical experience regarding the relationship between acceptance and change, the clinical relevance of the Buddhist notions of gaining idea and basic goodness. The author also explores relationships between presence as actuality and ideal; knowing and not knowing; wonder and doubt. Clinical material supports the theoretical aspects of the discussion.     

Psychoanalytic attitudes towards homosexuality: An empirical research

Homosexuality is a challenging subject for the psychoanalytic community, which is now rethinking some of its basic theoretical and institutional assumptions. In recent decades psychoanalytic theory has changed, and the classical psychosexual model has been challenged. After a short review of major psychoanalytical theories of homosexuality, the authors focus on the existence of contrasting attitudes towards homosexuality. This plurality of theories and their clinical and institutional consequences stimulated the authors to investigate the relationship between the individual analyst's theoretical model and his/her clinical practice. The authors present the results of empirical research conducted in the Italian psychoanalytic community on the attitude of psychoanalysts towards homosexuality and the implications for cultural, theoretical and institutional issues. A questionnaire was sent to 600 psychoanalysts (206 of which responded), members of the five main Italian psychoanalytic institutions. First, analysts' personal characteristics and preferred theoretical models were investigated. Second, the respondents responded to statements eliciting their theoretical and clinical approach towards homosexuality. Results indicate that: a) cultural and theoretical background influences the analysts' attitudes towards homosexuality more than gender; b) there is a discrepancy between analysts' theoretical position and their clinical practice; and c) IPA institutes are more discriminatory towards homosexual colleagues than are Jungian ones.     

The clinical language of Sándor Ferenczi: Introductory and methodological considerations

Abstract

Reflecting in the present paper on the legitimacy of a work to collect together the ideas, concepts, and terms of Sándor Ferenczi, the author will explore, through a series of questions and answers, the following points: why it is so clear-cut that Ferenczi should be included in the company of those great psychoanalytic authors who might be deemed entitled to such a study; whether Ferenczi possessed his own language, and if this was the case, when and how he acquired it; what we mean when we refer to Ferenczi’s idiomatic language, and how we can profitably identify this language and bring it into focus; how, in practice, such a text should be organized; what its audience and function would be; and how it would be used by readers and students of Ferenczi.     

A SUPPLEMENT TO FREUD'S CASE HISTORY OF “FRAU EMMY v.N.” IN STUDIES ON HYSTERIA 1895

Speech, the associating stream of verbalizations, is the mode of communication par excellance in psychoanalysis. Authoritative literature of the psychoanalytic situation (Stone, 1961) and technique (Greenson, 1967) hardly mention the question of analysis of non-verbal behavior. Characteristically we have to search rather far back in time to unearth the literature in this field.     

IUSAM-APdeBA: A higher education institute for psychoanalytic training

The history of the last century shows the almost constant presence of psychoanalysis in the academic setting and, simultaneously, the incredible absence of analytic training at the universities. This paper outlines the project of the Buenos Aires Psychoanalytic Association (APdeBA) to create a higher education institution of its own (IUSAM) specifically aimed at lodging psychoanalytic training within a university setting. The project was approved by the Argentine educational authorities in 2005 and received the economic support of the International Psychoanalytical Association (IPA). The academic structure of the university is described, whose goal is broadened to the interdisciplinary field of mental health with psychoanalysis as an integrating axis. Some of the characteristics of the traditional 'university model' as well as its relationship with psychoanalysis are pointed out. With the IUSAM, psychoanalytic training is not included as a part of an already established university, it rather creates a new one, with the support of a well-known psychoanalytical association (APdeBA) which endorses its activities and guarantees its identity. IPA's requirements for analytic training (didactic analysis, supervisions and seminars) have been fully preserved in this new context. Finally, some of the advantages and disadvantages of including analytic training into an academic environment are listed .