Psychoanalytic Couple Therapy: Classical Style

In this essay, the core concepts of psychoanalysis are set forth as the context for the application of classical psychoanalytic theory to the practice of couple therapy. Infantile sexuality and aggression are shown to have a powerful role in the interpersonal lives of family members. The repetition compulsion structures marital interaction and intergenerational dynamics. The intrapsychic emphasis of classical ego-psychology is viewed in the interpersonal arena, and the author suggests adding to the Oedipus and Narcissus myths a myth that resonates with this shift in emphasis. In introducing the “Pygmalion–Galatea process,” the author captures the universal attempt to change the psychic dynamics of the other or others. This ultimately mutual process begins with the infant's mirroring of its caretakers—which includes language acquisition. Much of human interaction is fueled by subsequent attempts to create others in our own images of them and by their reactive compliance or resistance to that dynamic. Three case illustrations are presented to show how these phenomena manifest themselves in marital interaction and in dreams.     

Applying Psychoanalysis to Couple Therapy: The Treatment of a Couple with Sexualized Persecutory Internal Objects Resulting from Trauma

The application of psychoanalytic theory and technique to the treatment of couples has been relatively overlooked despite the long history of concern by psychoanalysts with the role of marriage in individual development and suffering. This paper uses an example of marital and sex therapy to illustrate the application of psychoanalytic object relations theory to couple therapy, and describes the way that in-depth treatment of the couple's persecutory object relations that follow severe trauma can be effectively conducted. The paper concludes with a brief discussion of issues of shame and guilt in psychoanalytic theory and their relevance to this couple.     

Reversing the negative cycle: interpreting the mutual influence of adaptive, self-protective measures in the couple

The author discusses factors that shape the subjective meanings each member of the couple gives to marital interactions and the intersubjective disjunctions between the partners that can result. These include adaptive, self-protective mechanisms, the wish for mastery, guilt, and defense against grieving. Through illuminating these factors, psychoanalytic couple therapy can enhance empathic awareness of how each partner's attitudes, actions, and once adaptive defenses can actualize the other's transference expectations and evoke his or her painful and traumatic childhood relationships and experiences.     

Marital conflict and marital intimacy: an integrative psychodynamic-behavioral-systemic model.

A conceptual model of some of the intrapsychic and interpersonal forces that stimulate and maintain repetitive, nonproductive marital conflict behavior is presented. In this model, concepts derived from psychoanalytic and social-learning theory and integrated within a family systems framework. Implications for conjoint therapy with conflictual couples are discussed.     

Training analysis in the dutch society for psychoanalytic psychotherapy: A survey of attitudes and feasibility

SUMMARY

As is the case in many training courses in psychoanalytic psychotherapy, one of the training requirements of the Dutch Society for Psychoanalytical Psychotherapy (NVPP) is a training analysis, currently a minimum duration of 700 hours. During the last few years, this requirement has become somewhat controversial. Because the NVPP does not have information about the current interest in NVPP membership, the Board of the NVPP decided to do a survey. Of 995 psychiatrists, clinical psychologists and psychotherapists, who had recently completed their training, or were still in training, 623 filled in a questionnaire. Of those who are interested in the NVPP training, 39 per cent judged the training analysis as not feasible in terms of time, and 61 per cent in terms of money. Forms of personal treatment thought desirable for anyone who wishes to become a psychoanalytic psychotherapist at a specialist level are, in descending order, psychoanalytic psychotherapy (63%), psychoanalysis (39%), psychoanalytic group psychotherapy (25%), and psychoanalytic marital or family therapy (6%). Respondents who judge personal analysis as not feasible, also tend to judge psychoanalysis to be equivalent to other forms of psychoanalytic psychotherapy, whereas those who judge personal analysis as feasible, tend to think that personal analysis is essential for a psychoanalytic psychotherapist at the specialist level.     

The neurobiology of fear memory reconsolidation and psychoanalytic theory

Advances in both experimental neuroscience and psychoanalytic theory and technique have made it possible to consider mechanisms by which psychodynamic psychotherapies might have an impact at the cellular and molecular level. Here potential analogies are drawn between (1) the mechanisms and results of blocking the reconsolidation of conditioned fear memories in the laboratory and (2) several key aspects of psychoanalytic process. A review of the biology of conditioned fear memory, including differences between extinction and inhibition of reconsolidation, indicates that this biology may have relevance to various ways in which psychoanalytic therapy is effective. The ideas proposed here might lead to further experimental attempts to understand the molecular biology of psychoanalysis.     

Moments of change in psychoanalytic theory: Discussion of a new theory of psychic change

This commentary briefly summarizes the model proposed by the Boston Group and attempts to place it in the context of attachment theory and other integrational attempts between cognitive science and psychoanalysis. The clinical implications of these ideas are considered, with particular reference to therapeutic technique and the role of the therapist, as a “new object.” Some suggestions for the further development of the model are considered, in particular the observational study of the therapeutic process, the use of some classical psychoanalytic ideas such as transference, and the need for using the model to encourage technical innovation in psychoanalysis. © 1998 Michigan Association for Infant Mental Health     

The adaptive significance of destructiveness in primitive personalities

Destructiveness in primitive personalities is not restricted to a segment of the person as it is in the case of neurotics, but is global and pervasive. This destructiveness is meaningfully configured in a manner which cannot fully be accounted for by constitutional factors or be comprehended from the individual, intrapsychic, conflictual viewpoint of classical psychoanalysis. It follows an interpersonally meaningful pattern and therefore has adaptive significance in the contemporary life of the individual. The adaptive model I propose does not violate essential canons of psychoanalytic theory, for it can simultaneously be conceptualized in terms of intrapsychic structure and dynamics. This model holds out the possibility for a therapeutic approach to primitive personality organization which differs in some but by no means all respects from classical analysis.     

The efficacy of couples-based interventions for panic disorder with agoraphobia

From this systematic literature review it was concluded that panic disorder with agoraphobia (PDA) can sometimes occur in conjunction with marital problems. Couples-based treatments for PDA – partner-assisted exposure and marital therapy – can be an effective treatment for the condition. It is as effective as individually based cognitive behaviour therapy. Involving partners of people with PDA in therapy may be appropriate in some cases, particularly those in which there are marital difficulties. Couple-focused interventions may enhance the maintenance of treatment gains by facilitating interactions that positively reinforce and perpetuate attempts by people with PDA to enter feared situations and cope with these effectively. People with PDA who have good marital relationships show a better response to both individual and couples-based treatment programmes. In some instances effective couples-based treatment leads to improvement in marital adjustment as well as in PDA symptomatology.     

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.     

Has infantile sexuality anything to do with infants?

Classical psychoanalytic theory draws many concepts from mental processes that are assumed to arise in the infant and influence the adult mind. Still, psychoanalytic practice with mothers and infants has been integrated but little within general psychoanalytic theory. One reason is that only few analysts have utilized such practice to further theory. Another reason is that infant therapists tend to abandon classical psychoanalytic concepts in favour of attachment concepts. As a result the concept of infantile sexuality, so central to classical theory, plays an unobtrusive role in clinical discussions on infant therapy. The author argues that infantile sexuality plays an important role in many mother-infant disturbances. To function as a clinical concept, it needs to be delineated from attachment and be understood in the context of mother-infant interaction. Two examples are provided; one where the analyst's infantile sexuality emerged in a comment to the infant. Another is a case of breast-feeding problems with a little boy fretting at the breast. This is interpreted as reflecting the mother's infantile sexual conflicts as well as the boy's emerging internalization of them. Thus, to conceptualize such disorders we need to take into account the infantile sexuality in both mother and baby.     

Out of the consulting room and into the world: hermeneutic dialogue, phronesis, and psychoanalytic theory as practice

One of the relics of positivism has been an underappreciation of the moral and ethical dimensions of psychoanalytic theory and practice. In a positivist metapsychology, cure and therapeutic gain were often defined instrumentally, with relatively little consideration given to aspects of human experience (e.g., moral, cultural, spiritual) that did not fit within a positivist framework. Conceptual and paradigmatic shifts in psychoanalysis have occurred, in part, because of the inability of the classical model to provide a language that adequately captures deeply felt human values and beliefs. Aided by hermeneutic and postmodern influences, many contemporary psychoanalytic theories are beginning to focus greater attention on the notion that analytic therapy is empowered by a set of ethical convictions, beliefs, and commitments, which are tied to a certain understanding of the good life. Along these lines, the author argues that developing a fresh understanding of the moral and ethical dimensions of psychoanalysis requires elaborating a new ontology of human subjectivity and social life. The author offers a sketch of how this gargantuan task might be started by integrating psychoanalysis within a hermeneutic perspective on dialogue, by suggesting that it would be helpful to view psychoanalysis as promoting Aristotelian practical wisdom or phronesis, and by rethinking psychoanalytic theory and interpretation as a form of practice.     

PSYCHOANALYSIS AND COGNITIVE BEHAVIOUR THERAPY ‐ RIVAL PARADIGMS OR COMMON GROUND?3

The author suggests that contemporary enthusiasm for cognitive‐behavioural therapy reflects our longing for swift, rational help for psychological suffering. Competition for funding threatens the psychoanalytic presence in the public sector. The psychoanalytic and cognitive‐behavioural models are contrasted, and the relative richness of the psychoanalytic paradigm outlined. The author suggests that a cognitive model is commonsensical, but less complex, with less potential explanatory and therapeutic power. She discusses how the analytic stance is always under pressure to ‘collapse’ into simpler modes, one of which resembles a cognitive one. This also occurs inevitably, she argues, when attempts are made to ‘integrate’ the two models. Cognitive and ‘integrated’ treatments nevertheless have the advantage that they are less intrusive and hence more acceptable to some patients. Selected empirical process and outcome research on cognitive and psychoanalytic therapies is discussed. Brief psychotherapies of either variety have a similar, modestly good outcome, and there is some evidence that this may be based more on ‘dynamic’ than ‘cognitive’ elements of treatment. Formal outcome studies of more typical psychoanalytic psychotherapy and of psychoanalysis itself begin to suggest that these long and complex treatments are effective in the more comprehensive ways predicted by the model.     

Individual,Marital, and Family Therapy

Two therapists have recently suggested that marital therapy is either a shadow of individual therapy (Robert Harper) or eclipsed by family therapy (Jay Haley). We offer an apologia for marital therapy. We suggest that empirical evidence shows that it works. Further, clients often request it and resist a redefinition of marital concerns as individual or family problems. Finally, people value a focus on the marriage because (a) it blends individual rights and communal responsibilities and (b) it is the only voluntary relationship between dyads with the family. We conclude that marital therapy, when requested and appropriate, is legitimate and effective.     

Passions in girls and women: toward a bridge between critical relational theory of gender and modern conflict theory

This paper considers (1) some aspects of the lack of dialogue among psychoanalytic schools; (2) Brenner's (1982) conception of drives and drive derivatives as inextricably linked to relationships, and some of its less-appreciated implications; (3) the debate over the importance of childhood sexuality in mental life; (4) the attempts by relational theorists to address and reintegrate the role of sexuality and gender, particularly in the study of feminine psychology; (5) the problematic role of aggression in psychoanalytic theories of women; (6) the avoidance by both men and women of women's passions and their anatomical loci, especially the clitoris, whose only function is the provision of pleasure; and (7) the suggestion that an integrated theory, including an understanding of the role of the body as well as of the passions and the defenses against them, results in the most effective clinical psychoanalytic approach. It then suggests that a bridge could be built between a relational point of view that takes into consideration the role of bodily experiences, and a classical point of view in which drive is seen as inextricably linked to relationships from birth on.     

Sex and Sexuality: An Evolutionary View

In this article, I first offer a summary of Darwin’s main ideas, especially relating to sex, and explain how these have been elaborated by more recent evolutionary scholars. I then give an account of the historical divergence between psychoanalysis and classical Darwinian thought, and describe how the early psychoanalyst Sabina Spielrein tried to counter this by addressing some biological themes in her work. Following a review of some contemporary attempts to bring psychoanalysis and evolutionary thought into alignment with each other, I make some suggestions regarding a view of sex and sexuality that would be sound in evolutionary terms while also being helpful in psychoanalytic ones.     

Infantile defences in parent‐infant psychotherapy: The example of gaze avoidance

Findings from parent‐infant observational research have stimulated the development of intersubjective models of psychotherapeutic action. These models have brought out the infant as an interactive partner with the parent. Conversely, interest in describing the individual psyche of the baby has decreased, especially the unconscious levels of his/her experiences and representations. In parallel, clinicians and researchers have been less prone to apply classical psychoanalytic concepts when describing the internal world of the infant. The author argues that this is inconsistent with the fact that psychoanalytic theory, from its inception, was founded on speculations of the infant's mind. He investigates one such concept from classical theory; the defence. Specifically, he investigates if selective gaze avoidance in young babies may be described as a defence or even a defence mechanism. The investigation links with Selma Fraiberg's discussion of the phenomenon and also with Freud's conception of defence. The author also compares his views on the baby as a subject with those suggested by infant researchers, for example, Stern and Beebe. The discussion is illustrated by vignettes from a psychoanalytic therapy with a 3 month‐old girl and her mother.     

Psychosomatics: a current overview

The term 'psychosomatic' has typically defined a series of illnesses in which somatic injury breaks out from psychic conflict not recognized as such. Currently, health is considered the only psychosomatic state of integration of mind and soma: an ideal state of integration. Somatic pathology is an effect of mind/body splitting. In the heterogeneous 'field of psychosomatics' interaction between psyche and soma ranges from classical psychosomatic illness to sporadic episodes in which the body has responded to an inability to process mental conflict. The author briefly reviews the development of psychoanalytic thought on psychosomatics in Argentina. He suggests the need to find appropriate conceptual tools to approach the mental structure underlying this pathology. He presents his ideas about the mental functioning of patients with somatization disorders. He introduces the concept of somatic event as a restitution phenomenon through which the subject attempts to re-establish self-integration and links with reality. He also offers some reflections on temporality and on changes in psychoanalytic technique with these patients. A clinical case illustrates his ideas.     

An empirical study of seriously disturbed suicidal patients

Aspects of unconscious processes in a group of seriously disturbed psychiatric patients are examined in an effort to predict near-lethal suicide attempts and explore psychoanalytic formulations of suicide. The Rorschach Inkblot Test, the most widely used projective measure in suicide research (Bongar 1991), was chosen for its potential to shed light on specific unconscious processes. Psychic states commonly associated with suicide were measured by psychoanalytic Rorschach analog scales and then subjected to a progression of statistical analyses in order to predict future occurrence and lethality of suicide attempts. On the basis of a priori hypotheses, the authors developed a suicide index comprising four psychoanalytic Rorschach signs that predicted, with considerable accuracy, which patients would later make near-lethal suicide attempts. The best predictors were unconscious processes indicative of penetrating affective overstimulation, disturbance in the capacity to maintain adequate ego boundaries, and depressive affective states characterized by a morbid preoccupation with death and inner decay. These findings provide empirical support for several well-known formulations of the unconscious motivations for suicide.     

Countertransference in group psychotherapy

This paper attempts to up-date our understanding of countertransference in the therapy group setting. After a brief review of some of the psychoanalytic and the group psychotherapy literature dealing with countertransference, the paper points out the vulnerability of the group therapist and presents examples of possible countertransferential situations, such as stereotyped roles, reactions to external aspects of patients, and therapists' insecurities. It concludes by suggesting ways in which group therapists can become more sensitive to their countertransferences.