The role of support in psychoanalysis.

A two-factor theory of clinical psychoanalysis is proposed. In accordance with the predominant position of the structural-adaptational ("classical") approach in psychoanalytic theory, the power of interpretation and insight in clinical psychoanalysis has received ample attention in psychoanalytic literature. There seems, however, to be a growing awareness among analysts that not all the facts of an analytic treatment can be accounted for by this approach alone. A second factor is increasingly recognized: the power of adequate support provided by the analyst and resulting in a specific experience by the analysand. In the application of the developmental ("postclassical") approach of psychoanalytic theory, the importance of this support-experience factor in the treatment of ordinary neurosis by means of ordinary psychoanalysis is emphasized. The relative neglect of this aspect of clinical psychoanalysis may be indicative of the present-day dilemma of how to translate advances in theoretical knowledge of mental development into the therapeutic praxis of psychoanalysis. There may, however, be another important reason. Support and experience are phenomena often occurring on the nonverbal level. In contrast to interpretation and insight, they are usually not voiced, let alone distinctly and loudly expressed. They are the silent power of psychoanalysis.     

On the scientific standing of psychoanalysis

This paper speaks for the claim that psychoanalysis qualifies as a scientific enterprise. It will derive from the conceptual and evidential structure of psychoanalysis a causal empirical hypothesis that admits of scientific intraclinical testing. Relevant topics from the philosophy of science (especially the nature of causal explanation and the work of Grünbaum) and the psychoanalytic theories of pathogenesis and therapeutic action are discussed in a preliminary way to create a framework for the demonstration. The dynamic unconscious is examined as the core causal concept of psychoanalysis. Taken together with an account of the structure of the mental apparatus, a coherent picture of mental causation (the propagation of an unconscious impulse) comes into view. This leads to the formulation of a set of clinical propositions that unite to generate a causal empirical hypothesis based solely on data from the analytic setting--namely, that the transferences and symptoms that appear in free association in the analytic situation possess an interrelational structure that is theoretically implied and can be statistically confirmed.     

Psychoanalysis, psychoanalysis appropriated, psychoanalysis applied

The assumptions which predominate in the reading of psychoanalytic theory differ from those involved in listening to the patient in the psychoanalytic process. A weakness of much applied psychoanalysis is that these two sets of assumptions are confused and theoretical certainty is substituted for clinical exploration. This difference in assumptions is illustrated by the different assumptions about the signifier in two poems. In Freud's work on Leonardo, both attitudes toward the signifier are present, but the clinical aspect is located in Freud's method, not in his historical construction. The problems of maintaining a similar clinical stance in applied psychoanalysis are explored, and Freud's tendency toward historical certainty is speculatively considered as an instance of the parallelism phenomenon.     

Pluralistic approaches to the study of process and outcome in psychoanalysis. The LAC depression study: a case in point

Approaching process and outcome in psychoanalysis is a topic that touches on ambitious and complex epistemological and methodological issues. As discussed in the first part of the paper, in keeping with challenging epistemic considerations, it would seem appropriate to describe the specificity of psychoanalysis as a specific scientific discipline of the unconscious (spezifische Wissenschaft des Unbewussten, see LIT). Psychoanalysis, over its more than 100-year history, evolved a range of highly advanced research methods for investigating the specific object of its research, namely unconscious conflicts and fantasies. Hence, like many other scientific disciplines, contemporary psychoanalysis comprises a plurality of theories, methods of clinical treatments as well as a plurality of research topics. This position is discussed with reference to a model illustrating different forms of clinical and extra-clinical research in psychoanalysis. A major, ongoing comparative study of outcomes of psychoanalytical and cognitive behavioural, long-term treatments of chronically depressed patients, the so-called LAC-study, serves to illustrate the richness of contemporary research in psychoanalysis.     

Foundations of psychoanalysis reconsidered

Grünbaum's approach to psychoanalysis suffers from several difficulties. It imposes a standard of logical reductionism and methodological purity that not only violates the nature of psychoanalytic knowledge, but imposes an invalid standard of verification and scientific confirmation. It utilizes a brand of dichotomous reasoning that forces psychoanalytic propositions into artificial positions that do not reflect the actuality of analytic practice. It imposes a standard of verification that is impossible for psychoanalysis, along with all forms of psychological knowledge, to reach. It visualizes psychoanalysis as encompassing only one form of knowledge of human psychic life, forcing it into a model that eliminates other aspects of the psychoanalytic process, so that psychoanalysis is subjected to criticism only on one dimension among several--a kind of psychoanalytic straw man. The psychoanalysis that is so impaled often is difficult for the psychoanalytic practitioner to recognize. To the extent that Grünbaum's skillful and highly informed criticism of the philosophical bases of psychoanalysis encounters these difficulties, the value of his argument falls short of providing a useful basis for advancing psychoanalytic knowledge and particularly for promoting the quest for pertinent standards of validation within psychoanalysis.     

Ethology and psychoanalysis

Ethology has sometimes been considered a distant, perhaps quaint discipline which on occasion has peripherally enriched psychoanalysis. In contrast to this, it is suggested that the evolution of ethology, which is barely seventy years old, has, to a remarkable extent, mirrored the development of psychoanalysis. A comparison is made between the classical instinct concept in psychoanalysis and the classical ethological concept of instinct; and a parallel between the fate of the concept in each discipline is drawn. It is further suggested that the dialectical relationship and complementary evolution between ethology and psychoanalysis stems from both disciplines having introduced into an explanatory model of human behavior an element that was innate, instinctual, genetic—in short, biological.     

The aim of psychoanalysis

The changing aims of psychoanalysis are discussed with reference to Money-Kyrle's paper on the subject. The theory of dammed-up libido, the theory of moral conflict and the theory of misrepresentations and perversion of reality which he described, all imply different aims. It is argued that, in addition, the theory of projective identification leads to a radical change in the aim of treatment which can now be formulated in terms of helping the patient regain lost parts of the self.     

Expressions of vernacular psychoanalysis

The present paper examines the clinical integration of theory and experience from the perspective of clinicians’ subjective shaping of inquiry. The author suggests that the historical, conceptual development of clinical psychoanalysis parallels the progressive articulations of consensual understanding within the clinical hour. He suggests that the clinician's utilization of vernacular elements, derivative of direct experience as well as of reference to the wider range of psychoanalytic thinking, addresses gaps and disconnections within the abstract understanding of the clinical psychoanalytic process. Providing examples from psychoanalytic history, he concludes with a contemporary example of psychoanalytic papers, reflecting vernacular elements that are of use to practicing clinicians.     

On the efficacy of psychoanalysis.

In this study we critically review the formal research literature pertinent to the outcomes of psychoanalysis and the factors influencing these outcomes. Our inquiry was conducted from a psychoanalytic perspective. We found the research yield consistent with the accumulated body of clinically derived psychoanalytic knowledge, e.g., patients suitable for psychoanalysis derive substantial therapeutic benefit; analyzability and therapeutic benefit are relatively separate dimensions and their extent is relatively unpredictable from the perspective of initial evaluation among seemingly suitable cases. The studies all contain clinical and methodological limitations which are no more substantial than in other forms of psychotherapy research, but they have not substantially advanced psychoanalytic knowledge. This raises challenges for the further development of formal research strategies native to psychoanalysis.     

Variations of the past. Reflections on memory in contemporary psychoanalysis

In Jewish thought, contradictory positions may be legitimate. This is seen in Freud´s position in relation to tradition and memory: remembrance is valuable, but so is a movement forward. The main claim of this paper is that psychoanalysis in this respect has changed. While in especially the early Freudian position, one could see a stress on the importance of going back to earlier times, object relation theory mainly stresses the importance of facilitating new functions. This change has been especially clear during the last two decades. As cases of example, the use of neurocognitive models in psychoanalysis as well as Fonagy’s theory are discussed. The consequences of the shift from a bidirectional to a unidirectional, forward-looking, psychoanalysis, are discussed.     

The trajectory of psychoanalysis: A prognosticationy3

I present an overview of the development to this point of psychoanalysis as a discipline'both as a theory of the mind and a treatment of the disorders of the mind' and offer a prediction concerning evolving development over its (near) future. My focus is on the coherence of psychoanalysis as a theoretical structure, starting with Freud's strenuous endeavours to maintain the psychoanalysis that he had single‐handedly created as a unitary and unified theory, tracing then the breakdown of this effort, even in Freud's lifetime, into the burgeoning theoretical diversity or pluralism that characterises worldwide psychoanalysis today, and then going on to the beginning appearance of evidences' not yet widely remarked' of growing convergences from within very disparate and even seemingly very opposed theoretical perspectives, at least at the level of technical interventions and experience‐near clinical theory, with implications, however, even for the level of experience‐distant general (metapsychological) theory. Such a development, if sustained, as I anticipate, would strengthen the credibility of psychoanalysis as a science of the mind, amenable to growth through empirical research in accord with the canons of scientific method.     

Regulation and standards for psychoanalysis: The place of the Other in psychoanalysis and its teaching

In numerous Western countries, psychotherapies have come under increasing governmental regulation. A more recent development is the increasing scrutiny given to psychoanalysis in the United Kingdom, in France, and in the United States. This paper examines a particular document that was created by four professional psychoanalytic organizations that are based in the United States. The document called Standards of Psychoanalytic Education aims to develop criteria that would guide accreditation and the organization of psychoanalytic institutes. The document is part of a set of concerns and actions related to the state regulation of psychoanalytic practice, its professional status, and the protection of those who seek its services. The essay examines the putative theoretical neutrality of this document by unfolding its tenets in terms of Lacanian psychoanalysis, a school of psychoanalysis that would take exception to many of the ideas suggested in the document's template for psychoanalytic education. The paper follows one line of argumentation throughout: what is the place of the Social Field, the Symbolic Other, within psychoanalytic process and as a recourse for professional legitimization that stands outside of psychoanalysis? As a practice of particularity, what relation does the discipline bear to other mental health fields and to the norms and knowledge systems of the mental health professions? Using a Lacanian orientation, two senses of the Other are discussed, and the specificity of psychoanalysis is asserted. This specificity is contrasted with some of the goals and constraints that are introduced by current approaches to regulation.      

The manifest dream in psychoanalysis: a clarification

Controversies about the value of the manifest dream in psychoanalysis are usually a matter of semantics. The author concludes that two clinically meaningful questions about the manifest dream can be asked: Is the patient's report of a dream useful in formulating an interpretation if no formal associations to the dream elements are given? Inasmuch as such reports always include some kind of associations, and the analyst always possesses considerable knowledge about the patient, the answer to this question would seem to be "Yes, at least at times." In what ways can the manifest dream contribute to our understanding of the dream and the dreamer? Both the literature and clinical experience indicate that there are many ways; these are summarized in an appendix. One approach, the direct decoding of manifest dream elements, is discussed in some detail. Several examples of the undisguised appearance of memories of childhood traumatic experiences in the manifest dream are presented.     

Rosalia H.: with Freud in a prelude to psychoanalysis

Abstract

The case of Fräulein Rosalia H. is discussed quite briefly by Freud in one of his contributions to Studies on hysteria. This case of ‘retention hysteria’ was included in another much longer case study, and it is designed to illustrate how a ‘mnemic symbol’, which operates to condense a group of memories, may be formed during the course of an analysis. A new symptom thus appears which may throw more light on the circumstances which gave rise to the presenting symptom. Despite the richness of this case, Freud does not refer to it again in his writing and there has been very little discussion of it in psychoanalytic commentaries. This paper explores how the case serves as a transition point from pre-psychoanalytic conceptions of symptomatology and clinical practice, and how it can be read as a prelude to psychoanalysis proper.     

Historiography and psychoanalysis

Abstract

The act of writing the history of psychoanalysis poses crucial questions with regard to the openness of society. This article examines the fundamental issues faced by researchers when they set about writing the history of psychoanalysis in a specific country. The significance of reconstructing features of the psychoanalytical practice is discussed. The opposition that exists between the current academic ideals and those of the psychoanalytic societies is outlined with reference to the changes that society has undergone, particularly during the past 30 years. In this context, the stance maintained by psychoanalysts with regard to psychiatry, academic psychology, and the university education of psychotherapists is defined. Government accreditation processes for psychologists and psychotherapists are likewise illustrated in the light of the opinions held by psychoanalysts at different moments in time.     

On teaching psychoanalysis

Teaching psychoanalysis is no less an art than is the practice of psychoanalysis. As is true of the analytic experience, teaching psychoanalysis involves an effort to create clearances in which fresh forms of thinking and dreaming may emerge, with regard to both psychoanalytic theory and clinical practice. Drawing on his experience of leading two ongoing psychoanalytic seminars, each in its 25th year, the author offers observations concerning (1) teaching analytic texts by reading them aloud, line by line, in the seminar setting, with a focus on how the writer is thinking/writing and on how the reader is altered by the experience of reading; (2) treating clinical case presentations as experiences in collective dreaming in which the seminar members make use of their own waking dreaming to assist the presenter in dreaming aspects of his experience with the patient that the analytic pair has not previously been able to dream; (3) reading poetry and fi ction as a way of enhancing the capacity of the seminar members to be aware of and alive to the effects created by the patient's and the analyst's use of language; and (4) learning to overcome what one thought one knew about conducting analytic work, i.e. learning to forget what one has learned.     

The use of dreams in the clinical context: convergencies and divergencies: an interdisciplinary proposal

This paper aims to define some unexpected convergences and foreseeable divergences regarding the conceptualization of dreams and their use as a research tool, specifically in clinical practice with non-neurotic patients. It includes a concise review of different lines of thought on the vicissitudes of dreams throughout the history of psychoanalysis: from their initial conception up to their use to examine transference and relational aspects in the context of a psychoanalytic process. The idea of the merely evacuative function of dreams from patients in certain diagnostic categories is discussed and compared with that of their potential communicative value. Lastly, the essay sets forth an interdisciplinary semiotic-pragmatic approach to the function of dreams and their clinical and technical use in the context of the intersubjective dynamic field. Based on the hypothesis that dreams related in the session are communicative signs, this proposal argues their significance as a symbolic matrix that generates processes of psychic semiosis. To do so, it combines certain lines of psychoanalytic thought with ideas coming from C. S. Peirce's analytic semiotics. Clinical material is included to illustrate this viewpoint.     

Towards a biblical psychoanalysis: a second look at the first book

Freud's materialistic treatment of religion has discouraged and stigmatised inquiries concerning the potential theoretical and clinical utility that biblical stories could offer to the ongoing development of psychoanalysis. As a result, the historical development of psychoanalysis has been disproportionally influenced by the Hellenic ideals that influenced the German humanistic pedagogical value of Bildung, to which Freud was an ardent disciple. However, since it has consistently been recognised that Western culture has been mutually influenced by both biblical and Hellenistic attitudes, it may be warranted to extend this dialectal interplay into the realm of individual psychology, in the process delimiting a space whereby psychoanalysis and biblical thought can constructively coexist. In this vein, prototypical myths from the Greek and biblical traditions can reliably be situated on a psycho-mythological continuum, with Greek myths representing a less integrated level of ego development and biblical narratives reflecting an unambivalent, higher level of psychological organisation. The Greek mythology of Oedipus and the biblical Binding of Isaac has been chosen to illustrate this dynamic.     

Cognitive difficulties in psychoanalysis

The author rises a number of questions about cognitive difficulties in relation to psychoanalysis. He presents the case of an adult patient in whom previously unrecognized childhood cognitive difficulties were discovered during the course of analysis. Their relationship to the patient's problems in adulthood is discussed. Some suggestions and speculations about the questions raised are presented with the hope of stimulating further exploration of what the author considers to be an interesting and important subject for psychoanalysis.     

The basic tools of psychoanalysis

The objective of psychoanalysis is to help the analysand make the contents of his or her psyche conscious to him- or herself In this paper, the author identifies four tools central in the attempts to reach this goal: (1) the analysand's self- observation; (2) the analyst's assistance in identifying the obstacles to self-observation (i.e., resistance analysis); (3) the analysand's bringing unconscious contents into the sphere of self-observation with the help of the analyst's interpretations; (4) turning the analysand's tendency to account for the listener into an object of self-observation (i.e., the analysis of transference). Of these tools, the first is regarded as the most fundamental; all methodological instruments used in psychoanalysis aim at enhancing the scope of the analysand's self-observation. Some difficulties in keeping this aim are identified, and the analysand's autonomy in this work is pointed out, leading to the conclusion that the analysand never becomes changed in an analysis; the analysand might, however, change him- or herself as a consequence of a newly-won self-observation.