Love in the counter-transference: The uses of the therapist's excitement

SUMMARY

The psychoanalytic tradition has always had difficulty with the question of the therapist's sexual feelings toward the patient. This paper traces that difficulty: from Freud's original struggle to replace moralism with a psychoanalytic mode of understanding, to the more recent literature on countertransference which still seems particularly averse to the possibility of the therapist's sexual experience. By way of a discussion of a psychoanalytic psychotherapy, I argue for the sometimes central therapeutic role of the therapist's experiencing, and then containing, excitement.     

Female psychology: a review

This paper examines the differences between early psychoanalytic views of female development and current views, illustrating that recent suggested revisions offer an updated preliminary theoretical framework. The clinical implications of the differing views are discussed, and examples (two from the psychotherapy of children and a third from the psychoanalysis of a young woman) are offered to demonstrate particular clinical issues, such as penis envy and genital anxiety. It is postulated that the outcome of psychoanalytic treatment of women is markedly affected by the different clinical formulations and conceptualizations that result from different views. Further, the psychoanalytic terminology can contribute in subtle ways to ambiguity, distortion, and lack of clarity regarding female psychology.     

The Gap Between: Being and Knowing in Zen Buddhism and Psychoanalysis

The author discusses various relationships derived from the image of gap, precipice, and abyss with specific emphasis on interacting dynamics between being and knowing as explicated in the Zen Buddhist teachings of Hui-neng and in the psychoanalytic writings of Wilfred Bion. While of significant value to psychoanalysis, it is argued that symbolic meanings can occlude the actuality of the analysand's or of the spiritual seeker's affective experiencing, particularly concerning the human tendency to concretize experiential states engendered through meditation and/or the psychoanalytic encounter. The author draws from Matte-Blanco's explication of symmetrical and asymmetrical perceptual modalities to discuss the fluid nature of spiritual experiencing, paradoxical coexistence of ultimate and relative realities and reciprocal dynamics and identities between states of experiencing that might otherwise appear opposed. The primacy of experiencing for both disciplines, particularly concerning the experiencing subject's momentary state of consciousness, forms a central theme for both Zen and psychoanalysis. Brief clinical vignettes support and illuminate the author's points.     

Bindungstheorie und Psychoanalyse

Bowlby’s attachment theory and more recent versions of it are examined from an epistemological viewpoint and subjected to questioning on whether they are in line with central psychoanalytic concepts. It is argued that Bowlby’s basic tenets regarding attachment theory, which later attachment theorists never seriously questioned, do not conform to scientific standards, and that psychoanalytic issues such as the dynamic unconscious, internal conflicts, the interaction between drive wishes and defence in establishing substitutive formations are either ignored or not treated in sufficient depth. In the light of this, the assertion that psychoanalytic criticism of attachment theory arose from mutual misunderstandings and is outdated nowadays stands the matter on its head: psychoanalytic criticism can only be regarded as outdated if either psychoanalysis, or attachment theory or both are misunderstood.     

Psychoanalytic Treatment: Thick Soup or Thin Gruel?

One way to evaluate a psychoanalytic theory is to picture a therapist with that theory in his mind and imagine what happens when we fold him into the basic soup of psychoanalytic procedure. Because the background forces of analytic treatment are so influential, the practical outcome cannot be predicted from the details or the validity of the theory alone. Thus, we should not assume that newly discovered items of neurophysiology and infant observation are ever what is actually being dealt with in psychoanalysis. To illustrate this principle, I select two recent theories derived from observational studies, and explore the likely effects that a therapist's belief in them would have on seven dimensions of the psychoanalytic situation. Theories set the therapist's attitude, the attitude affects the background forces, and the total effect of all of that constitutes the significance of the theories for psychoanalytic treatment.     

Revisiting the Psychoanalytic Object: Introduction

Senior analysts from different theoretical orientations are invited to express their conceptions of the nature of the psychoanalytic object and its place in their clinical approaches. I provide the rationale for this updated survey on the object, drawing on recent procedural notions of its formation, and on the broader range of patients now seeking help whose difficulties foreground use of the analyst-as-object. Certain common themes among the writers emerge, including concern with the dialectic of the separability and unity of subject and object. Most strongly, the object’s personalized meaning for each writer, as for all analysts, confirms its robustness and generativity as a psychoanalytic concept and entity.     

Identification: psychoanalytic and biological perspectives

In recent attempts to bring psychoanalysis into greater contact with other sciences, a number of works have explicated neural science concepts and phenomena--affect, memory, consciousness--for the psychoanalyst. These efforts have helped analysts build a more scientific foundation for their theory and practice. A related task remains--namely, to take psychoanalytic concepts and see how they relate to other sciences. The concept of identification has a long history in psychoanalytic theory. It is seen in parent-child interactions, in teaching and mentoring relationships, and in psychoanalysis and psychotherapy. Neuropsychology and evolutionary biology have explored the phylogenetic precursors of identification, while genetics and infant observation provide insights into individual processes of identification. Finally, neuroscience, particularly recent studies of mirror neurons, offers information about the biological mechanisms of imitation and the relationship of imitation to identification. Findings from these sciences are presented in an effort to further the psychoanalytic understanding of identification, especially its biological underpinnings.     

A thought on the nature of psychoanalytic theory

In this paper I suggest that much of recent experiment in analytic theory, even widely diverse approaches, has a common denominator the problem of the conceptual vacuum created by the shift away from a central creative position of the idea of psychic mechanisms. I try to illustrate, by comparing theories of Bion and George Klein, that this movement seems to point in the direction of considering now what is uniquely psychoanalytic about our theories. I content that what is unique about psychoanalytic theories is that they are involved in the experiential core-function of the applied science by becoming internalized and used symbolically to aid the analyst inwardly to endure persecutory anxiety and loss of the sense of objective reality, and so maintain the analytic position.     

Therapeutic technique in psychoanalysis and psychoanalytic psychotherapy.

As the distinctions between what we consider to be psychoanalysis and what we consider to be psychoanalytic psychotherapy have become more uncertain and more blurred, it follows that it is equally difficult to designate the techniques that would be appropriate and specific for each modality. The problem has been compounded by the fact that in recent years psychoanalysis in the United States has become considerably less homogeneous than in the past and the ego-psychological structural model is no longer the only point of view in the psychoanalytic marketplace. Further, with alterations in the criteria for analyzability, cases which, generally, had not been viewed as suitable for analysis, have been appearing with increasing frequency on psychoanalysts' couches. We have also recognized that the degree of congruence between our expectations from and the results of psychoanalytic treatment was often less than anticipated. It appears that analysts have become considerably less arbitrary about what psychoanalysis is and how a psychoanalysis can be carried out. The author is unable to delineate one technique that is intrinsic to and limited to psychoanalysis. There are, however, differences in degree and emphasis in the ways in which various techniques are applied in the therapy of psychoanalysis as compared to the therapy of psychoanalytic psychotherapy. Special attention is given to the role of a psychoanalytic process and the central place the analysis of resistance plays in psychoanalytic therapy.     

Understanding violence: Does psychoanalytic thinking matter?

A coherent psychoanalytic theory of violence has been hindered by the very few psychoanalysts who have actually worked with violent patients, by political allegiance to certain psychoanalytic schools of thought, a naïve belief that all violence is typically not intentional, but rather a problem of impulse control, and the lack of understanding of recent neurobiological findings concerning aggression. Although intensive psychoanalytic treatment is usually not appropriate for violent individuals, the authors assert that a comprehensive understanding of violent behavior from a psychoanalytic perspective is of relevance for all mental health practitioners interested in the nature of human aggression. Actual violence is informed by bodily enactments and regressions to primitive subjective states; the effects of trauma on representation and symbolic functioning; the demarcation between affective and predatory violence; and understanding how all of our mental processes, including cognitions, wishes, memories, unconscious phantasies, ego-defenses, and object relations, are originally rooted in the body. The authors review the historical psychoanalytic literature on violence and critique contemporary psychoanalytic theorizing regarding the etiology of violent behavior in the light of some neurobiological research findings. They conclude with treatment recommendations for those clinicians whose patients have been violent toward others.     

When Interpretation Derails the Patient: The Negative Impact of Certain Misuses of the Concept of the Unconscious

Alternatives to classical psychoanalytic theory and technique have existed in the form of various "deviant" schools, all of which have found that contemporary conflict theory fails to achieve good results with the patients they treat. While the principles of interpersonal, self-psychological, intersubjective and relational schools are reasonably well known through the psychoanalytic literature, the opportunity to examine detailed analytic accounts by classical analysts has only recently become possible. The publication of full case reports has recently become a feature of the traditionally based psychoanalytic journals. This paper makes use of a recent volume of the Psychoanalytic Quarterly to examine the interpretations made during a lengthy analysis of a male patient struggling with his ambivalence about marrying his fiancée. The analyst repeatedly attributes his patient's reluctance to marry and negative feelings about his fiancée as determined by his unconscious conflation of his mother and his fiancée. The author attempts to demonstrate the derailment of the patient by these interpretations. They prevent him from solidifying his own judgment and, in so doing, prevent him from taking suitable action. An alternative approach to the material of the case is presented, including very different interpretations that would, in the author's opinion, liberate the patient rather than derail him from achieving his life goals.     

Reply to benjamin

Action and insight form an essential dialectic within the psychoanalytic process. Yet many recent psychoanalytic formulations, while emphasizing integration, have continued to view psychoanalytic and action‐oriented techniques dichotomously. It is reasoned that certain behavioral‐cognitive techniques that promote adaptive behavior can become an active part of an in‐depth analytic experience, providing material for an exploration that results in new ways not only of relating but also of experiencing the self and others. Such an approach, while at times helpful to certain patients, can be counterproductive for others. An integrative approach is compatible with many recent psychoanalytic frameworks emphasizing a two‐person psychology, but not with a one‐person vision of the psychoanalytic situation; in the two‐person view, it is reasoned that an integrative approach is capable of maintaining the integrity of the analytic process. The outlined technique reflects a relational psychoanalytic orientation emphasizing internalized object relations, with the use of action‐oriented techniques organized by the superordinate goal of modifying psychic structure, conceptualized principally in terms of self‐ and object‐representations. Reasoning that this approach is congruent with certain theoretical contributions from Gill, Mitchell, Sandier, and especially Wachtel, among others, I state underlying assumptions of the approach, preliminary technical guidelines, and illustrative case material.     

The psychoanalytic process: the developmental and the integrative

Psychoanalysis is a treatment that focuses on intrapsychic events and activates integrative tendencies to promote-insights. Almost from the time it originated, however, it was also promoted as a therapy informed by the interpersonal, inducing change through experiences generated within the psychoanalytic situation. In recent years the interpersonal or object relations approach has come to be categorized as "developmental," a term that fosters no end of ambiguities. The resulting confusion compromises the study of the actual developmental process on the one hand and the structure-enhancing features of transactions on the other. This encumbers research on the psychoanalytic process. The author distinguishes the intrapsychic from the interpersonal, the integrative from the developmental, and the two very different realms of psychological activities currently advanced as "developmental."     

The scientific status of psychoanalytic clinical evidence (I)

The main source of evidence for psychoanalytic theory comes from the clinical situation. Yet recent empirical studies in verbal conditioning and the social psychology of persuasion indicate that psychoanalysts and therapists of other schools are speciously validating their own theories by unwittingly influencing their patients’ behavior. In the light of this evidence it is small wonder that psychoanalysts consistently ‘validate’ psychoanalytic theory in their clinical practice while therapists of other schools ‘validate’ their own theories in their clinical practice. Although Freud was not unaware of the problems of ‘suggestion’ and the conflicting evidence of rival schools of psychotherapy, he never met these problems successfully. Contemporary psychoanalysts have added little to Freud's original position. One recent attempt, by Fritz Schmidl, to formulate new criteria for the correctness of psychoanalytic clinical interpretations, does not completely escape the problem of suggestion and has new problems of its own.     

Attachment theory and psychoanalysis Some remarks from an epistemological and from a Freudian viewpoint1

The author examines Bowlby's attachment theory and more recent versions of it from an epistemological viewpoint and subjects it to questioning on whether they are in line with central concepts of Freudian psychoanalysis. He argues that Bowlby's basic tenets regarding attachment theory, which later attachment theorists never seriously questioned, do not conform to scientifi c standards, and that psychoanalytic issues such as the dynamic unconscious, internal confl icts, interaction of drive wishes and the role of defence in establishing substitutive formations are either ignored or not treated in suffi cient depth. In the light of this, Fonagy's assertion that psychoanalytic criticism of attachment theory arose from mutual misunderstandings and ought nowadays to be seen as outdated is reversed: psychoanalytic criticism can only be regarded as outdated if either basic tenets of Freudian psychoanalysis, or attachment theory or both are misunderstood.     

Psychoanalytic observation

The recent focus on empathy as the essential activity in psychoanalytic data gathering has underemphasized the complexity of psychoanalytic observation and has failed to identify what truly makes it unique among modes of psychological investigation. It is a process that includes introspection and empathy. However, it also includes the analyst's observation of the patient's behavior, and particularly verbal behavior, in a way that is not necessarily empathic. The psychoanalytic use of introspection and behavioral observation together, as they are modified by the analysand's free association and the analyst's evenly hovering attention, provides a unique method of data gathering. The transient, mutually related regressions of analyst and analysand which partly constitute the analyzing instrument modify the field of observation available to both, providing better access to derivatives of the analysand's unconscious mental functioning. This more complex concept of psychoanalytic observation, as opposed to that in which empathy is predominant, has important implications for psychoanalytic training, clinical work, and theory.     

In Retrospect: Reflections on a Psychoanalytic Career

This account of the author's psychoanalytic education and the subsequent evolution of his theoretical and technical beliefs emphasizes his sustained attachment to classical Freudian principles. The refinement of his views consequent to his close friendship and collaboration with Charles Brenner is described. In recent years, his study of the work of certain colleagues who are exponents of other psychoanalytic points of view has resulted in some modulation of his technical stance, without altering his fundamental convictions about the nature of the psychoanalytic enterprise.     

Envy: the canker in the bud

This paper explores the relevance of the concept of moral masochism as a response to early trauma and the implications of this for psychotherapy.

Consideration is given to early conceptualisations of moral masochism within the psychoanalytic literature, in particular, the move from drive theory to object relations. More recent developments in relation to trauma and defences, such as disassociation, are explored. It is suggested that a more complex and fuller understanding requires thinking about the subtle and shifting interaction of both these levels. This allows the possibility of building a more nuanced understanding which can look at both behaviour, as described in the trauma literature, and meaning which is the core of a more classical psychoanalytic approach.

Case histories are used to illustrate the linkages between moral masochism and trauma and the transference and countertransference dynamics and challenges involved. Progress varied in these cases, with both positive and negative outcomes. This theoretical background is used to suggest why this may be so.     

Psychoanalysis and general psychiatry: obsessive-compulsive disorder as paradigm

To certain areas once dominated by psychoanalytic conceptualizations of psychopathology and pathogenesis, general psychiatry has in recent years made significant contributions. The obsessive-compulsive disorder is cited as an example, and illustrations of such contributions are described and discussed. Some implications for psychoanalytic theory and research are suggested.     

The peer supervisory group for psychoanalytic therapists

The recent interest in peer supervisory groups for psychoanalytic therapists raises important questions regarding both psychoanalytic training and group process. The present paper explores these issues and suggests that there exists a continuum from case-centered peer supervisory groups to process-centered peer supervisory groups. Transference and countertransference and the recognition of parallel processes in psychotherapy supervision are examined in their relation to the supervisory group experience. The authors suggest that the model a therapist employs regarding the role of countertransference will most likely influence the kind of peer supervisory group that s/he will choose. Further, there are specific techniques, as well as experiences, which may foster alteration of the group's psychic organization. Illustrative case examples are provided throughout.