Psychoanalysis of a patient who received a kidney transplant

A young man who had glomorulonephritis at age five was treated psychotherapeutically for an anxiety neurosis with phobic and obsessional features. He was referred for psychoanalysis at a time when he was approaching kidney failure, but was referred back for more psychotherapy with the possibility of future psychoanalysis. He underwent renal dialysis and then received a kidney transplant from a brother. The psychoneurosis became worse, and a psychoanalysis was begun about one year after the transplant operation. The clinical report illustrates the developmental effects of the childhood illness, as well as the patient's response to the adult treatment and the renal transplant. Nonanalytic observations by others on renal dialysis and transplant patients are reviewed and compared with the findings in this analysis. The psychoanalysis of a renal transplant patient is feasible if other indications for analysis are present. A previously unreported finding is the problem of changing a lifetime adaptation from illness to relative health. This involved the analysis of the narcissistic conflicts of the oedipal stage of development as well as the preoedipal maternal transference.     

The older patient in psychoanalysis

The demographic shift toward extended longevity has led to a commensurate increase in the length of the working and productive years, and with it an increase in the number of so-called "older" patients who come into psychoanalysis or psychoanalytic psychotherapy. This led the Psychoanalytic Research and Development Fund to support a four-year study by a small group of experienced psychoanalysts of "the older patient in psychoanalysis." Aging and old age are considered to be the final developmental crisis of the successive epigenetic phases of the life cycle. Eleven case presentations and various briefer clinical vignettes informed us that older and even old individuals, who seek treatment themselves or who are appropriately referred, respond in a positive and effective fashion to psychoanalysis and psychoanalytic psychotherapy. As do younger patients in analysis, such older people, motivated by the wish to make the most of what time is left, become interested in understanding their pasts with respect to the present and the future. The life stories of two older men who undertook analysis, and the courses and outcomes of their analyses, illustrate our findings and impressions. In both cases conflicts and difficulties from earlier developmental phases, extending back even as far as the oedipal and preoedipal years, were revived during their older years. And although these conflicts might have been beyond definitive resolution, what is salient is the extent to which they were ameliorated: sufficiently that they did not impede a satisfactory adaptive solution of the final crisis of the normative sequences of the life cycle.     

精神分析语境中的移情

“移情”是精神分析学、移情美学、移情心理学、移情伦理学和移情现象学的一个核心概念,但它是一个典型的“同名异义词”。精神分析学的“移情”特指弗洛伊德提出的“übertragung”概念,而后四种理论的“移情”指的是“Einfühlung”,本质上是“共情”或“同感”。在精神分析学内部,移情与投射、反移情、共情等概念紧密相关,而不同流派对这些概念的理解不仅不同甚至完全对立。在精神分析学外部,移情美学、移情心理学和移情伦理学虽然与精神分析学共享了投射或“移置”意义上的“移情”概念,但二者的用法存在本质差异。胡塞尔的现象学反对在投射或移置的意义上理解移情,把移情看作自我以第一人称方式对他人精神生活的深入感受、对异己主体及其体验行为的经验。现象学的移情概念既有助于澄清“移情”(übertragung)与“同感”(Einfühlung)的混用所造成的误解,也有助于理解二者间的关联和作用机制。