On understanding projective identification in the treatment of psychotic states of mind: The publishing cohort of H. Rosenfeld, H. Segal and W. Bion (1946–1957)

A publishing cohort of Kleinian analysts – Rosenfeld, Segal and Bion – implemented Klein's (1946) notions of projective identification and the 'paranoid ' and 'schizoid ' positions in the understanding of a group of psychotic disorders. The author differentiates Klein's (1946) Notes on some schizoid mechanisms paper from its revised version of 1952, maintaining that it was Rosenfeld's clinical work during this period that helped to centralize Klein's redefinition of projective identification. The stage was set for Segal 's contribution in terms of 'symbolic equations,' where the psychotic's attack on the breast left him incarcerated in internal torment and persecution, where things-in-themselves were confused with what they symbolically represented. Segal in turn linked psychotic to normal, paranoid–schizoid to depressive positions, where by means of projective identification and symbolic imagination, the patient could arouse feelings in the analyst related to sadness, guilt and loss. Bion assumed that psychotic pathology reflected disordered thinking, when the severely disturbed used language as a mode of action. The psychotic was profoundly confused between the use of thought and action in the natural world – where thought was required, he preferred action and vice versa. Bion also drew upon projective identification in a new, broader way, so that analysis could now become more of an intersubjective, bi-directional field of projective and communicational influence between patient and analyst. The paper concludes with the impact of the work of Rosenfeld, Segal and Bion and variations on the technique of analyzing psychotic states in terms of the patient's early history, transference and countertransference.     

Psychoanalytic case presentations in a weaving thoughts group: On countertransference and group dynamics

This article summarizes experiences of psychoanalytic case presentations in weaving thoughts (WT) peer groups. The format is presented and illustrated using a session with a group of analysts. In this setting, the frame of the presentation is guaranteed by the moderator. One aim is to create a group setting with many parallels to the analytic situation. A second aim is to discourage members from becoming enmeshed in destructive group functioning, such as internal disputes that may block a deeper understanding of the material. Classical psychoanalysis permits the analyst to reflect behind the patient on the transference-countertransference interplay. However, such reflections may be marred by undetected countertransference problems. Different supervision formats have different ways of helping the analyst with them. The WT format 'copies' the analytic session to the group, hence each member associates to the material in peace. Meanwhile the presenter looks, metaphorically speaking, at the web of their associations at his or her own pace. This may help him or her to confront and reflect on unresolved countertransference issues. This article indicates the method's similarities and differences compared with other formats. Arguments are supported by a child psychotherapy session, but the method is equally suitable for adult case material.     

Cultural function and psychological transformation in psychoanalysis and psychoanalytic psychotherapy

Cultural experience of silence and individual vicissitudes between talking and being silent infl uence the way individuals form an alliance and pursue the analytic process. This is of relevance both for the patient and for the psychoanalyst/therapist. The author describes a patient, whose silent phase occurred in the fi fth and sixth year of intensive psychoanalytic psychotherapy. She suggests that a) the silence functioned as a protection of a space for the core self and promoted inner transformation and psychologicaldevelopment;b)thesilenceinvolvedatransference-countertransference matrix with projective identifi cations of the patient's internalized mother- and father-related objects that caused a tenuous balance between maintaining and erasing the relationship between the patient and the author; c) the silence phase was highly infl uenced by the author's own cultural background and what she brought into the relationship of tolerance of being silent in the presence of another, and understanding of the many complex functions of silence. During the silent phase the patient moved from simply describing and naming her affects and inner experiences or expressing them as somatic processes, to being able to internally access and verbally convey her own affects and experiences in the therapeutic alliance. This process involved both affect desomatization, affect differentiation, and affect verbalization.     

Being a psychoanalyst: An everyday audacity1

This paper is the work of fi ve psychoanalysts who came together as a group in order to refl ect on their work as analysts. How are we analysts to identify the unconscious resistances that may sometimes hold us back from offering psychoanalysis to some patients? Do these resistances sometimes hamper the inner freedom that we require in order to maintain a psychoanalytic focus once that process is under way? How do we manage from time to time to overcome these resistances or, better, make use of them in order to develop our understanding of the unconscious dynamics that create the link between analyst and patient? The authors discuss these issues with particular reference to clinical situations taken from classic psychoanalytic treatment cases during which the analyst had to fi nd within him‐ or herself the audacity to be a psychoanalyst. Each clinical situation is different: preliminary interviews, in the course of the actual treatment, issues that emerge in the training of candidates. One of the signifi cant features of this group lies in the fact that the participants are at different stages in their development as psychoanalysts (student, associate member, full member, training analyst). This means that their experiences complement one another and encourage a discussion of issues such as how psychoanalysis can be passed on, and the relationship between supervisor and supervisee.     

The role of the patient's remembered history and unconscious past in the evolution of Betty Joseph's 'Here and now' clinical technique (1959-1989)

The author historicizes one aspect of Betty Joseph's ongoing technical contributions in terms of its originating London kleinian context. Early on she drew upon both the patient's remembered history and unconscious past, linking these experiences in past-to-present transference interpretations in order to effect psychic change. In evolving the technique of 'here and now' analysis, Joseph came to emphasize a communicative definition of projective and introjective identification as well as the significance of enactments while marginalizing the use of part-object anatomical interpretative language. She gradually set aside directly linking the patient's past with the present, compelled now by making direct contact with her patients. She now tracked how difficult patients acted in and responded to interpretations from moment to moment. The author maintains that the explicit and implicit conceptual work of Wilfred Bion as well as Joseph's continuous group workshop for analysts led to an increased understanding of the patient's projective impact on the analyst's countertransference responses, and thereby increased the analyst's capacity with 'difficult to treat' narcissistic spectrum patients described by her colleague, Herbert Rosenfeld. In recent work, while Joseph continues to elucidate what patients recall about their early past, she formats her understanding in terms of a direct analysis of the structure of the patient's projected internal object relations in the transference. The analyst works with the patient's communications and enactments, with a greater emphasis on a more 'inside-to-outside' understanding of transference in contrast to the earlier 'past-to-present' work associated with both Freud and Klein. This investigation concludes with one example of Betty Joseph's significant impact on contemporary kleinian technique by taking up some of Michael Feldman's work. Now the analyst listens to the 'past presented,' the patient's projected internal world, as well as tracks how the patient hears and subtly mishears interpretations for defensive, equilibrium-maintaining purposes, as the analyst attempts to effect psychic change by widening the ego's perceiving functions.     

Psychoanalysis,science, and art: Aesthetics in the making of a psychoanalyst1

This paper critically examines the relationship of psychoanalysis to science and art. Its point of departure is Michael Rustin's theorizing. Specifically, in considering the possibility of a psychoanalyst's having an aesthetic orientation, the author analyses: 1) the difficulty of there being any connection between psychoanalysis and science because science's necessarily presupposed subject‐object dichotomy is incompatible with transference, which, beginning with Freud, is basic to psychoanalysis; 2) the complex relationship between psychoanalysis and aesthetics using Maurice Merleau‐Ponty's philosophical perspective as well as Luigi Pareyson's theory of aesthetics; 3) the Kantian foundations of the psychoanalytic notion of art as the ‘containing form of subjective experience’ 4) intersubjectivity, without which clinical practice would not be possible, especially considering matters of identity, difference, the body, and of sensory experience such as ‘expressive form’; 5) the relationship of psychoanalysis and art, keeping in mind their possible convergence and divergence as well as some psychoanalysts' conceptual commitment to classicism and the need for contact with art in a psychoanalysts's mind set.     

MAX EITINGON AND THE STRUGGLE TO ESTABLISH AN INTERNATIONAL STANDARD FOR PSYCHOANALYTIC TRAINING (1925‐1929)2

This paper deals with the first years of the IPA's International Training Commission (ITC). The author begins by outlining the Berlin model of training, including some less familiar aspects, and he describes how the foundation of the ITC in 1925 was designed for promoting the general establishment of institutionalised training according to this pioneer model. In relation to lay analysis, he highlights the issue of central power versus local autonomy with regard to admission policy. The latter part of the narrative is devoted to an ITC subcommittee (‘Eitingon Committee’), appointed in 1927, which tried to formulate training guidelines for the whole IPA, again with a clear Berlin profile. The discussion of the draft of these guidelines among all branch societies (with Freud himself participating) revealed some interesting disagreements, while the ‘closed’ nature of the system, as opposed to what later came to be called an ‘open system’, was hardly challenged. The initiative failed, apparently through American opposition, but essentially because of the developmental gap between local societies as to the institution of specialised psychoanalytic training. The paper is based largely on unpublished material and also provides some information about Max Eitingon, the least well known of the early leaders of psychoanalysis.     

Psychoanalysis in the university: the natural home for education and research

Psychoanalysis as a theory of human mental functioning and a derived therapeutic for disturbed functioning would have its natural home in the university, and Freud gave evidence of harboring such an ambition. But the sociopolitical structure of the early 20th century Austro-Hungarian Empire precluded this, and analysis developed, by default, its part-time, private practice-based educational structure. Psychoanalytic penetration of academic psychiatry in the United States after World War II made possible a counter-educational structure, the department of psychiatry-affiliated psychoanalytic institute within the country's medical schools. This paper outlines, beyond these, other more ambitious vistas (David Shakow, Anna Freud, The Menninger Foundation, Emory University [US], APdeBA [Argentina]), conceptions even closer to the ideal (idealized) goal of full-time placement within the university with strong links to medicine, to the behavioral sciences, and to the humanities.     

The clinical language of Sándor Ferenczi: Introductory and methodological considerations

Abstract

Reflecting in the present paper on the legitimacy of a work to collect together the ideas, concepts, and terms of Sándor Ferenczi, the author will explore, through a series of questions and answers, the following points: why it is so clear-cut that Ferenczi should be included in the company of those great psychoanalytic authors who might be deemed entitled to such a study; whether Ferenczi possessed his own language, and if this was the case, when and how he acquired it; what we mean when we refer to Ferenczi’s idiomatic language, and how we can profitably identify this language and bring it into focus; how, in practice, such a text should be organized; what its audience and function would be; and how it would be used by readers and students of Ferenczi.     

Medical psychotherapy consultation: psychoanalytic psychiatry for the patient and professional

An NHS Mental Health Trust Medical Psychotherapy Consultation Service using psychoanalytic psychiatry to help the patient and professional is described. The Consultation Service established in 2000 is offered to secondary acute and community mental health teams and primary care. The service was evaluated as a basis for regional and national development. Between 2006 and 2013, 87 consultations from 210 were sampled to ascertain demographic and diagnostic profiles and outcomes of the consultation process. We conducted an online survey of local consultant psychiatrists’ views about the service, and undertook a thematic analysis of the free text comments. We also conducted a survey of members of the Royal College of Psychiatrists’ Medical Psychotherapy Faculty to ascertain whether similar consultation services existed elsewhere in the UK and had been evaluated. The Leeds model of psychoanalytic consultation – a ‘consultation sandwich’ – is described. From a psychoanalytic perspective, the work of consultation is seen as an extension of the dynamic field of the analytic situation. This paper develops the concept of a bastion – an omnipotent reserve in and between the patient and professional derived from adhesive identifications leading to stuck relationships. The adhesive identification in the patient and professional acts like a ‘grievance glue’ – a mutual manifestation in a last bastion of painful limitations not faced, losses not grieved.     

Supervision, transference and countertransference

The author discusses supervision, transference and countertransference as seen in the context of the clinical case of a patient who had been first seen as a training analysis case and who later, in a fortuitous way, was treated by the supervisor of the training analysis. The supervisor, who in the first instance did not recognize the patient, discusses the reasons for this unusual experience in terms of the presence and absence of transference during the analysis of this patient as a training case and the problems inherent in the task of supervising. The patient's feelings towards the first and the second analyst and the vicissitudes of transference and countertransference during the supervision of the training analysis and its influence on the presentation of the analytical sessions by the student are also detailed and discussed. The question of recorded supervision presentations and their possible influence on the dynamics of supervision is raised.     

Terminated Seed: Death,Proprietary Kinship and the Production of (Bio)Wealth

What is mental disorder and how can it be identified? These are complex and multifaceted questions, given the multiple ambiguities that centre on the psychopathological concepts employed within contemporary psychiatry and psychology. Yet, scientists investigating mental disorders must successfully resolve these uncertainties if research is to continue. For neuroscientists studying the contested conditions antisocial personality disorder and psychopathy, psychiatric and psychological classifications and concepts are used to substantiate one another. This co-produces epistemological and ontological un/certainties, without wholly resolving philosophical and methodological questions regarding what mental disorders are and how they can be recognised. Indeed, these ambiguities are rendered (relatively) unimportant. This kind of practical uncertainty work is thus an important aspect of the investigative process, performing an essential role in the continuation of scientific knowledge production, the legitimation of professional orientations, and the validation of psychopathological concepts.     

Inside and outside the window: some fundamental elements in the theory of psychoanalytic technique

The underlying concern of this paper is that psychoanalysis as practised today is in danger of losing its specificity and so losing its way. The author suggests this is possible for three reasons: the problem analysts face in responding to the strong emotional demands the great majority of patients necessarily place on them, the unintended consequences of the apparent success of 'here and now technique' and the absence of good clinical theory. The paper mainly discusses the author's ideas about some core elements of the clinical theory that all psychoanalysts must use when they are working and proposes (at the risk of being facile) some relatively simple heuristics related to them which are meant to be helpful. Recalling Kurt Lewin's maxim that 'there is nothing so practical as a good theory', he will suggest that continuous reflection on how one is using theory in daily practice is highly practical, if the theory is good enough. Theory in fact is a necessary 'third' in psychoanalytic practice which, if kept in sufficient working order close enough to clinical experience, provides an ongoing and very necessary check on our sense of reality. But, of course, as a third it can, like reality itself, be the focus of both love and hate with equally problematic consequences. The paper starts with a clinical example of a difficult but apparently successful analysis reaching its end, which will be used throughout the paper to illustrate and elaborate the theoretical ideas set out.     

Grasping psychoanalysts’ practice in its own merits1

The central objective of this presentation is to reflect on the obstacles involved in the task proposed by the Chicago Congress, which is to explore convergences and divergences in psychoanalytic practice. The author discusses two major obstacles. First, the epistemological and methodological problems in relation to the construction of theory in psychoanalysis and especially the inaccessibility, in any reliable way, of what psychoanalysts really do in the intimacy of their practice. He proposes to separate, at least in part, theory from practice in psychoanalysis, in an attempt to grasp psychoanalysts' practice in its own merits. He then outlines a phenomenology of the practice of psychoanalysis, which reveals that, in their work with patients, analysts are guided more by practical reasons than theoretical reasons; that is, their interventions are predictions rather than explanations. Since these practical reasons need to be validated constantly in the analytic relationship based on their effects, he discusses the subject of validation in the clinical context of the core theory of therapeutic change in psychoanalysis, that is, the conditions required for clinical practice to satisfy the thesis of an inseparable union between gaining knowledge and cure. He ends by challenging the core of the psychoanalytic theory of change, arguing that it neither does justice to the practice of psychoanalysts nor to contemporary knowledge of processes and mechanisms of therapeutic change. Finally, he proposes that we detach practice from theory, in order to study the former in its own merits, utilising a plurality of methods ranging from systematic investigation to the recent methodology of the Working Party.     

The psychoanalytic vision of Hans Loewald

Hans Loewald is a comprehensive and original theorist on a par with any major post-Freudian thinker, yet neither his ideas nor his person have become the basis for a Loewaldian school or approach, and he is not as well known as other innovators of comparable quality. In this paper the author attempts to characterize the scope and depth of Loewald's theory-his vision of the psyche and psychic life, or metapsychology, his characterization of the psychoanalytic process, and his vision of the clinical and human goals of psychoanalysis. She suggests that Loewald holds in all of these realms, and without apparent contradiction, a doubled-emphatically ego-psychological and emphatically object-relational-perspective, and an equal commitment to both the first topography and the structural theory. His views throughout are undergirded by a bi-directional developmental view that centers on differentiation and integration. The paper includes brief reflections on how to assess psychoanalytic theories, like Loewald's, developed before empirical research that seems to challenge them.     

The crisis of psychoanalysis and psychoanalytical training: The suffering of the candidate on the long road towards qualifi cation1

The author assesses the impact of the so‐called ‘crisis of psychoanalysis’ on the training of candidates, and on those who accompany them through the course. Different causes of the most relevant symptom of the crisis, i.e. the diffi culty of fi nding patients for a four‐sessions‐weekly analysis, are considered. According to the author, analysts themselves must bear some of the responsibility for it. She draws attention to a number of interrelated phenomena, such as: trainees' tension in their encounters with potential analysands, due to awareness of their own needs as trainees; the necessity to accept very disturbed patients whose selection might arouse criticism from the training committee; analyses in which trainees seem to become patients' hostages because of ever‐present fears of interruption; the diffi cult construction of a psychoanalytic identity in trainees who also are in full‐time psychiatric practice; trainees' profound uncertainty about the future both of psychoanalysis in general and their own careers in particular. In agreement with Kernberg, the author stresses the importance of considering the ‘crisis of psychoanalysis’ as a phenomenon whose development may be infl uenced by the analysts themselves.     

From bastion to enactment: The ‘non‐dream’ in the theatre of analysis1

In this paper, the author's objective is to discuss models that express what occurs in the analytical situation. He demonstrates how early models relating to painting and sculpture, to history and archaeology, develop into other models that refer to the relationship between two people. He studies in depth the Barangers analytical eld with its obstructive bastions as a background to understanding what is currently valued as intersubjectivity in psychoanalysis. The container contained model and the phenomenon of recruitment are also discussed. The author uses clinical material to demonstrate how these models are linked to enactment, and a study of this concept provides evidence of the importance of the visual image, the dream and non‐dream, the affective pictogram, as privileged aspects for the understanding and evolution of thought in the analytical process. Its importance leads to a proposal of a model that uses the theatre as a metaphor for the analytical process. In this model, analyst and patient both participate as characters in the scenes, and simultaneously as their co–authors. The analyst should also be responsible for the direction of scenes, as well as acting as critic. His task is to prevent obstructive conspiracies (the non‐dream) and new meanings for the scenes, thus allowing the development of new scenes and plots, and the enlarging of the mental universe.     

The archive and psychoanalysis: Memories and histories toward futures

Abstract

The archive and psychoanalysis are reconnected in a new framework. The archaeological metaphor of psychoanalysis, the traditional view of archives as storehouses of historical items, and the notion of memory as storage are revised according to the conceptions of fluid and dynamic archival and memory systems. A combination of psychoanalytic models and cognitive memory research is proposed to form developmental archival theory that will take into account the changing contexts of memory, meaning-making, negotiation of interpretation, and knowledge regulation. The three phases of registration (archivalization, archivization, and archiving) are seen in the dynamics of unconsciousness–consciousness, and in relation to the archivists’ and researchers’ transferences to their records as self-objects, transitional objects or evocative objects. Becoming conscious of archives is a continuous journeying through the multiple registrations and narrativizations of archives in the interaction between non-declarative and declarative memory. The archive and psychoanalysis touch upon processes that are suggested to concern metamemory and metareflection (the interplay between meta-emotion and metacognition). The futures of archives and psychoanalysis call for context-sensitive remembering and being attentive to the co-constructive translations of personal and social memory. Opening archives and psychoanalysis toward the unprecedented, without closing histories and memories, is the interminable task of encountering the “missing moment.”     

IFPS 1960–1985: A new home for international and German psychoanalysis?

Abstract

The International Federation of Psychoanalytic Societies (IFPS) was established in 1962. The first 20 years of the Federation were a time when psychoanalysis was divided into so-called liberal and orthodox factions. The (then orthodox) International Psychoanalytic Association (IPA) did not admit all psychoanalytic societies, and some societies did not want to join it. In the IFPS, non-IPA-psychoanalysts from Europe, the USA, and South and Middle America came together to discuss their new approaches to psychoanalysis and to find ways to better cope with their patients’ problems. At the beginning an informal organization of autonomous societies, the IFPS persisted for 12 years without a charter. The first three secretary generals came from the German Psychoanalytical Society and greatly influenced the first few years of the IFPS. The IFPS held several international conferences, and new psychoanalytic societies became members. In 1977, after the VIth Forum in Berlin, the IFPS fell into an identity crisis. The conflicts centered on the assumption of responsibility, the authority of the members, and how to understand the aim and sense of the organization. This article deals with the theoretical background of the early IFPS and the development of its self-concept.