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.     

The relationship of the inner and the outer in psychoanalysis

What is internal and what is external according to psychoanalytic theory? This is a surprisingly complicated question. The terminology is often ambiguous and inconsistent as, for instance, in the use of terms like ‘object’ and ‘other’. The relationship between internal and external in psychoanalysis is analysed from a philosophical, concept analytical, developmental psychological, methodological and trauma versus internal dynamics point of view. It is argued that psychoanalytical writing is influenced by the authors’ need to create their personal psychoanalytic theory and language. This is seen as one of the main reasons for the terminological variety and ambiguity in psychoanalytic writing. It is also argued that one particular reason for difficulties concerning the internal–external terminology is the existential anxiety awakened by the threat of the essential aloneness of man. The consciousness of this has a tendency to fade and lead to unclear terminology. The importance of the transitional world as a resting place from the hard reality of this essential aloneness is emphasized. The transitional world is also seen as a necessary part of psychoanalytical practice, as an aid in striving for the truth and reality, important goals of psychoanalysis.     

Psychoanalysis as a creative shaping process2

The author first explains the concepts of creativity, play and aesthetic experience. He then outlines the psychoanalytic process as a creative one that shapes reality. Making a link between psychoanalysis and the humanities, he demonstrates that creative play is a fundamental aspect of the human experience of reality. Aesthetic experiences during the psychoanalytic process are comparable to the play by which children structure their world and artists' activity in following their urge to shape. Furthermore it is shown that creative actualisation testifies to a quasi‐biological need for coherence and structure. Through modern hermeneutics, the truth claims of aesthetic shaping can be established in epistemological terms. The basic principles of hermeneutics‐historicity, linguisticity and communicative experience‐find their psychoanalytic counterparts in memory, representational shaping and transference‐countertransference. Psychoanalysis is demonstrated to be simultaneously a science and an art. On the basis of a case history, aesthetic experience is shown to constitute a specific and unique form of access to psychic reality. Aesthetic experience and creativity do not only aid recovery from ‘bad psychological states’, they are also indispensable for the entire understanding of internal and external reality. It is possible to develop this understanding through a creative psychoanalytic attitude.     

Playing with reality

The authors explore the interpersonal aspects of the early development of an experience of external reality and the roots of this experience in primary intersubjectivity. They suggest some implications that this has for psychoanalytic work with the patient's experience of external reality. They argue that the external world is not an independently existing 'given', for the infant to discover, as is sometimes implicitly assumed. Infants acquire knowledge about the world not just through their own explorations of it but by using other minds as teachers. The experience of external reality is invariably shaped through subjectivities. The authors argue that at first the infant assumes that his knowledge is knowledge held by all, that what he knows is known by others and that what is known by others is accessible to him. Only slowly does the uniqueness of his own perspective differentiate so that a sense of mental self can develop. In clinical work we frequently observe the undoing of this process of differentiation, and understanding the underlying mechanisms can be helpful in managing the transference and countertransference consequences when the process has been derailed.     

Innen, Außen, Zwischen

The so-called “intersubjective turn” (or “relational turn”) in psychoanalysis is closely associated with the work of Winnicott. It was him who added a new dimension to the psychoanalytic theories of a separate inner world, a dimension focussing on the mediating processes between the separate spheres of psychic and external reality: a space between subject and object, drive and civilisation, Ego and reality — the “potential space” that unconsciously connects our self to the Other as well as to a shared physical and social world we live in. Winnicotts paradoxical notions of the self are traced in this paper and unwrapped from their often enigmatic, developmentally and epistemologically confusing veils: the infant who does not exist without a holding mother; who is not aware of his/her being held because of its evidence, and only has an experience when falling; who him-/herself creates that reality which is already there; who must destroy the object in order to use it; who can only be alone when another person is present. The author, starting from apparently narcissistic phenomena of the media society, rehabilitates the term of “in-between” in contemporary psychoanalytic discussion which for a long time was considered as suspect, as being part of a “non-psychoanalytic” superficial social psychology (as the intersubjective, the interpersonal or the interactive). Under the strong influence of Winnicott, and overarching the different schools, contemporary psychoanalysis is focussing on intersubjectivity and relationality. The paper is an appeal for reformulating classical intrapsychic concepts — including the theory of the unconscious—in intersubjective terms, thus unfolding a relational approach inherent in Freud’s metapsychology.     

大学生世界观、人生观、价值观形成中的接受机制

大学生三观形成过程是与接受对象和接受环境互动的过程。大学生的知识结构、价值取向、意志品格决定着其三观接受倾向及信念内化的过程。三观信息反映现实的深度 ,与接受者内在认知结构和观念的契合程度 ,影响着其被接受的程度。而接受环境具有验证、巩固或修正、改变原有的三观观念的作用。应赋予三观以更深厚的文化基础和精神内涵 ,增强其理论创新和与现实的贯通性。     

Making Music Together: Discussion of Gianni Nebbiosi’s “The Smell of Paper”

Finding life in our patients is a common goal for analysts. Historically this project had been defined as one of freeing unacceptable impulses from their imprisoning defenses with the analyst, via interpretation, then contrasting the patient’s internal fantasied reality with “actual” reality. Untangling fantasy from reality could free the impulses to provide energy for more realistic projects. This imagery stands in stark contrast to the fluidity of a contemporary relational conceptualization of human experience where our inner experience is now understood to be the lens through which we construct our vision of external reality, always a subjective perception. Clinical change—finding life—now depends more on the activation of a generative intersubjective process between patient and analyst, which contributes to the expansion of the patient’s subjective experience. Gianni Nebbiosi’s use of music and of mime to help him feel his way into his patient’s and ultimately into his own similarly defended experience demonstrates the creativity and idiosyncratic clinical approaches that emerge from a contemporary relational orientation. This orientation recognizes the analyst’s subjectivity as a fundamental tool of clinical change—a vehicle through which any theoretical approach will necessarily be shaped. Differing approaches to a clinical situation do not always simply reflect theoretical disagreements; they may also reflect the expression of the particular subjectivity of the analyst.     

Die mitgebrachte Hilfe

Based on three case reports psychotic transfer manifestations will be examined mainly with respect to their concrete quality. In the first case presented the main theme is a situative ??overpresence of concrete external reality??. For the most recent consultation the female patient appeared accompanied by a large dog and in this way initially created an oppressive scenario. During the course of the consultation this could be linked to the internal (emergency) situation of the patient and in this way the Dobermann could be transformed to ??Charly??. In the second case the concretism impressed as a totally dominating modus vivendi. The patient switched off broad areas of her emotionality and exclusively recognized concrete tangible objects and facts as the only valid reality. During the course of the treatment the ??misrepresentation of a useful object?? could be recognized as the center of this concrete world, an object from which the expectation was that it (half-heartedly) predominantly removed concrete deficiencies and therefore from which no emotional help can be expected. It will be presented how the (mental) development of the patient was additionally influenced by the schizophrenia of her father: she developed this ??concretization?? as a central ego function in order to be able to suppress an increasingly ??louder?? madness. In the third case example psychotic clefts and concinnities will be described which appear to damage the verbal thought process in an omnipotent fashion. A detailed examination shows, however, that these ??mad syntheses??, comparable with the astrophysical ??dark matter??, provide stabilizing functions of gravity.     

Reconstruction and perceptual experience: further thoughts on psychoanalytic listening

Freud's monumental shift to the fantasy theory heralded the view that "it is psychical and not material reality" which is our sole domain of inquiry. Yet despite theoretical agreement and cogent technical admonitions against concerning ourselves with absolute or "external" truths, psychoanalytic listening betrays a stance in which the analyst attunes to a reality other than that of the patient's inner world, assuming the position of arbiter--even if a silent one--of what is or is not "distorted" in the patient's perceptual experience. The central impact of perception as a significant component of the patient's inner experience--past and present--goes unattended. Clinical examples from differing theoretical persuasions are reviewed to demonstrate this occurrence. An alternative mode of listening is considered which assumes an underlying shift in outlook, suspending any notion that we can "know" what is "correct" in the patient's perception, while sharpening attunement to its clinical impact--as may be evidenced by a shift in affect or state, a turn of phrase, or the transient appearance of a symptom or old behavior. It is argued that such a stance will lead to a more singular focus on the patient's psychic reality, permitting the emergence of a deepening realm of psychic phenomena, enhancing the capacity of self-observation, and richly facilitating the reconstructive process.     

Aesthetics as evaluative forms of agency to perceive and design reality: A reply to aesthetic realism

Following a naturalist-realist point of view, this paper attempts to contribute to the metaphysical question of whether or not reality includes aesthetics. During evolution, cognitive agents have constructed (goal-directed) regulatory abilities forming anticipatory contents in the form of feelings regarding opportunities for interaction. These feelings are considered to be the fundamental part of an evaluative or (what in this paper considered as aesthetic) behavior through which agents show a preference to aspects of their external world. Thus, ‘aesthetic’ denotes an agential behavior based on an organization of processes integrated in a form that identifies, evaluates, and compares sources of interaction-success or error in specific aspects of external reality. While agents approach the same aspects of reality as they all interact with the same world, our claim is that aesthetic normativity cannot be an objective feature of this reality. This model overcomes problems of correspondence in the sense that an agent's actions and thoughts ought to react to any pre-given (aesthetic) quality or norm, while at the same time it emphasizes the self-directedness of aesthetic behavior that enables the development of creative forms of cognition.     

All holes are the same: Emerging from the confusion

The author describes a type of mental development in which the primitive libidinal value of faeces and urine is kept unaltered all through adulthood. In this instance, individuals harbour fantasies of projective identifi cation with the internal parents, denying their real dependence, which leads to a pseudomaturity. These fantasies are usually accompanied by anal and genital masturbation and have intense aggressive content. Furthermore, there is a signifi cant confusion among all body orifi ces, leading to an inability to distinguish the self from the object, the inner world from outside reality. Individuals with this type of development can only maintain limited object relations and have highly erotized excretory activities. Manipulation of faeces may occur. This structure works as a defence against breakdown, but may also provide pleasure as it gives the illusion of omnipotent control of the object, as typical in pathological organizations. The author presents clinical material and discusses the diffi culties of the analysis, in which the patient tries to seduce the analyst into colluding with his mental functioning, primarily as a means of communication as well as a projection of his despair and his disbelief in the analyst's ability to help him.     

QUANTUM REALITY AND ETHOS: A THOUGHT EXPERIMENT REGARDING THE FOUNDATION OF ETHICS IN COSMIC ORDER

The authors undertake a thought experiment the purpose of which is to explore possibilities for understanding moral principles in analogy with cosmic order. The experiment is based on three proposals, which are described in detail: an ontological, a neurological, and a moral proposal. The ontological proposal accepts from the phenomena of quantum physics that there is a nonempirical domain of physical reality that consists not of material things but of what is philosophically conceptualized as a realm of nonmaterial forms. This realm of forms is the realm of potentiality in physical reality that quantum physics posits as an indivisible Wholeness—the One. It is the ultimate reality because everything empirical is the actualization of its forms. The neurological proposal is the hypothesis that the brain is sensitive to the potentiality waves in the cosmic field, as ordinary measuring instruments in physics are sensitive to potentiality waves at the quantum level, so that the cosmic field can communicate with the human brain. The third proposal assumes that the communication with the cosmic field can translate into moral ideas and actions. Even though the three proposals underlying the thought experiment are highly speculative, they lead to definite implications that make sense in their own right and can be applied in a useful way. From the order of reality some simple rules of conduct follow that are identical with traditional moral rules but have the character of rules of well‐ness, leading to new aspects of Aristotle's concept of eudaimonia and Kant's concept of the highest good. In analogy with the structure of physical reality, where all empirical phenomena are actualizations of nonempirical forms, it is suggested that the structure of morality, too, is that of a tacit, nonempirical form that actualizes in explicit principles and moral acts through our consciousness. The tacit form is thought to exist in the realm of cosmic potentiality, together with all the other forms that the empirical world actualizes. It can appear spontaneously in our consciousness when needed, offering its guidance to our judgment and free will. Because it does not appear in the form of commandments accompanied by threats, the actions of the tacit moral form define a higher level of morality, similar to that offered by some aspects of the Christian teaching, where one acts not out of fear but on the desire to do things right.     

The use of stories as autistic objects

This paper reviews Frances Tustin's concept of the 'autistic object' and its development over the course of her writings. Clinical material from work with a 4-year-old boy is brought to suggest that the concept can usefully be extended to include such cultural artefacts as stories as well as the physical objects emphasized by Tustin. It is also emphasized that the awareness of reality which autistic objects are used to defend against refers both to internal as well as external reality. The paper argues that it is the function to which the object is put that is critical in determining whether or not it should be viewed as an autistic object.     

Unconscious phantasy as an obstacle and as a stimulus to knowledge

This paper underlines and explores the connections between emotional and cognitive development at a very early stage, starting from the psychoanalytic psychotherapy of a 4-year-old boy with autistic features. Development of the personality and development of the mind are shown to proceed together and to be interwoven when the therapist starts to help the child to modulate the terror and the rage related to separation. The development of the idea of a good nipple and the Introjection of it as a mental structure is considered an important step on the way towards separation between mother and baby and towards the formation within the baby self of a space where symbols of the external world can be placed. Autistic features are considered as an extreme form of denial of both internal and external reality.     

Does the Subject of Experience Exist in the World?

In this paper I attempt to show, by considering a number of sources, including Wittgenstein, Sartre, Thomas Nagel and Spinoza, but also adding something crucial of my own, that it is impossible to construe the subject of experience as an object among other objects in the world. My own added argument is the following. the subject of experience cannot move in time along with material events and processes or it could not be aware of the passage of time, hence neither of change nor of motion. the subject cannot therefore be identified with any neural process, function, or location since whatever goes on in the CNS is necessarily objective and part of the temporal flux. However this does not imply any form of dualism for experiences exist only for the subject whose experiences they are and hence they have no objective reality.     

忧乐圆融：儒家忧乐思想的核心特质

儒家肯定感性忧乐的自然合理性,但是认为感性忧乐有待于外,陷溺于感性忧乐,容易使人流于以物役心的异化状态。儒家忧乐思想的根本形态是德性忧乐,德性忧乐的根据是本心自足之德性。儒家以德性之忧作为德行修养的内在心理动力,德性之乐是在德性彰明过程中本心情感的自然涌现,可以统摄和超越感性忧乐,实现忧乐圆融。     

THE DISPOSITIONALIST DEITY: HOW GOD CREATES LAWS AND WHY THEISTS SHOULD CARE

How does God govern the world? For many theists “laws of nature” play a vital role. But what are these laws, metaphysically speaking? I shall argue that laws of nature are not external to the objects they govern, but instead should be thought of as reducible to internal features of properties. Recent work in metaphysics and philosophy of science has revived a dispositionalist conception of nature, according to which nature is not passive, but active and dynamic. Disposition theorists see particulars as being internally powerful rather than being governed by external laws of nature, making external laws in effect ontologically otiose. I will argue that theists should prefer a dispositionalist ontology, since it leads them toward the theory of concurrentism in divine conservation, rather than occasionalism, and revives the distinction between internal and external teleology. God on this view does not govern the world through external laws of nature, but rather through internal aspects of powerful properties.     

The Cocreation of Fantasy and the Transformation of Psychic Structure

This author argues that therapeutic action in child psychoanalytic psychotherapy rests with the creation and transformation of fantasy through play, which in turn shifts psychic structure. The paper details the treatment of an eight-year-old girl whose mother's inability to playfully participate in the inner world of her child interfered with the child's development of a fantasy life. The author suggests that the introduction of objective reality (i.e., interpretations that link the child's play with the real world) potentially impinges on and interferes with the transformational processes of fantasy. Developing the capacity to distinguish reality from fantasy does not take place through a forced accommodation to reality, but rather through the expansion of fantasy and a widening of the realm of the imagination. The elaboration of fantasy in concert with a parent or analyst is what builds the child's capacity to differentiate reality from fantasy.     

Sliding doors: some reflections on the parent–child–therapist triangle in parent work–child psychotherapy

The parental presence as therapy agents, namely as a medium and support for the therapeutic process, is one of the paradoxical parameters of working with children. Parental presence serves as a reminder of the need to find a balance between inner and outer reality. The door that is closed in the therapy room leaves a parent on the other side but at the same time provides the child’s inner world with more latitude to reveal itself. This paper examines the fabric of relations created in the therapeutic parent–child–therapist triangle (analogous to Britton’s conceptualisation of the parent–parent–child link). How does this triangular connection affect the ability to be with the silent self (Winnicott) when the parent remains (tangibly and symbolically) on the other side of the therapy door? This paper presents two clinical examples to illustrate the complex fabric of relations created in the therapeutic parent–child–therapist triangle and the interactions between the internal and external reality of the parent–child relationship.