The Position of Metapsychology in the Formation of Psychoanalytic Knowledge and the Concept of “I” (Ego)

Psychoanalysis is unique in that competence in the field can be achieved only through applying the method to oneself. Different psychoanalytic schools differ in their understanding of the unconscious, about how to approach it, or how to define the specificity of the psychoanalytic interaction. Consequently, there are differences in the criteria for the definition of the ‘good-enough analysis’. There are many different opinions about how to select candidates, organise the curriculum and length of training. To define psychoanalytic talent is difficult; the uncertainty in the definition of criteria to use for selection is great; the problematic overlap between personal analysis and training is constantly present; to achieve conditions in which learning and creativity can develop is complicated by trainee, supervisor and their relationship to the Institute. Confrontations about training are often heated and divergent, as well as repetitive. Systematic studies about psychoanalytic education are very few. After a short discussion of the different concerns about selection, personal versus training analysis and the ambiguities of the supervisory situation, the author gives a review of three studies on how psychoanalytic education—as viewed by trainers and trainees—is conducted and experienced at the Swedish Psychoanalytic Institute. Training is felt to be well grounded in theory and tradition; nonetheless most do not have a sufficiently clear picture of training as a whole. Both candidates and trainers see the development of a psychoanalytic identity as the goal of training, where the competencies to be acquired are equated with important personality qualities. The candidates have a feeling of “being chosen"; they “wish to belong to a group who share an interest and fascination for psychoanalytic thinking and theory". All praise the warm and open atmosphere, and the mutual and continuous evaluations and the deep involvement of all. The surge to be rooted in an overreaching psychoanalytic ethic, the culture of gratitude within the Institute and the devotion to the task to train psychoanalytic clinicians for the future may preserve an idealised image of psychoanalysis and the fantasy that psychoanalysts are exceptional persons and give a mystifying colour to the psychoanalytic profession. This might also stand in the way of a more radical change in the traditions of training—according to the rather drastically changing climate in which psychoanalysts of the future will have to work.     

Can psychoanalysis find its self?

There is a place for the theory of the self in psychoanalysis. To justify that claim, I return to an era in the development of psychoanalytic thinking about the self that preceded Kohut's formulations and that has set itself on a course of evolving a concept of the self more congruent with extant structural theory. I try to articulate the potential role of such a self-concept in connection with the issues of personal agency and subjectivity, complex personal qualities, areas of the complex interaction and integration of intrapsychic structures, object relations, narcissism, and internalization. The intent of this discussion is to facilitate the further development and articulation of the psychoanalytic theory of the self, particularly in terms of its integration with structural theory, to promote clearer thinking and more effective clinical efforts.     

Fostering the educational value of candidate evaluation

Approaches to fostering the educational value of candidate evaluation are presented, in view of the plethora of intra‐psychic challenges that combine with many other complexities of learning to work as an analyst. Four integrally interrelated practices have been found to address sensitivities inherent in candidates’ experience of training in general, and being evaluated in particular. When applied in concert, the institute's evaluative process not only becomes more considered, but also better promotes a psychoanalytic attitude and minimizes the intrusion of evaluators’ personal responses. The first is defining and employing in synergy criteria for clinical immersion based on demonstration of the development and deepening of an analytic process, as well as the development of psychoanalytic competencies. The second is mandating institute‐wide application of guidelines for assessment of progression/graduation that are clearly explicated to all candidates and faculty. The third is transparent and timely communication between candidates and their supervisors and progression advisors regarding progress essential to a sense of collaboration. Fourth the progression review process must be systematic and in‐depth, with built‐in consultative relationships serving as checks and balances on personal elements. The implementation and educational impact of these practices are considered in the case of one candidate.     

Psychoanalytic Interpretation as Pharmakon: Applying Derrida’s “Plato’s Pharmacy” to Psychoanalysis

This paper presents a metaphorical heuristic to expand psychoanalysts’ views on the nature and method of interpretation from an intersubjective perspective. It uses one of Jacques Derrida’s findings in his essay “Plato’s Pharmacy,” a critique of Plato’s Phaedrus, as a model of psychoanalytic interaction. A parallel is drawn between psychoanalytic interpretation and the pharmakon—an ancient Greek term for ‘drug’ that means both remedy and poison. From this comparison, the inescapable dependence of personal meaning on contextual factors, specifically the context of the clinical intersubjective field, is shown. As a result, when an interpretation is offered, the analyst cannot truly know if the patient will receive it as remedy or poison. By keeping the context-dependent nature of personal meaning in awareness through the use of the pharmakon metaphor, analysts increase their abilities of interpretive understanding. In further discussion, the classical psychoanalytic concept of ‘negative therapeutic reaction’ is presented as an example of a decontextualized and reified psychoanalytic construct that becomes superfluous when interpretations are viewed through an intersubjective lens as pharmakon. Without the burden of expectation for being the authoritative imparter of reality and truth, the analyst may now attend to the patient in a way that is more fluid and reciprocal, where the relational field becomes what is primarily interpreted. Further, practical clinical implications of the concept of pharmakon suggest that since the analytic interpretation is subjective in every respect, effective clinical practice cannot be reduced to rigid protocols of technique.     

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.     

Ist es utopisch, sich zukünftige Psychoanalytiker ohne besondere berufliche Identität vorzustellen?

The subject of the Identity of Psychoanalysis and of its representatives belongs to the orthodox psychoanalytic movement. Since about 15 years, under the presidency of J. Sandler, the International Psychoanalytic Association (IPA) has tried successfully to facilitate scientific research and to promote projects. If the resistance of influential analysts against empirical investigations further decreases, psychoanalytic movement and its unfavourable concommitants will be past. The development to a scientific community will no longer be hampered by controversies on professional identity. The question of identity was dominated by the idea of the so-called “strict, untendentious psychoanalysis” (Freud 1909b, S. 104, 1919a, S. 168). It never existed and could never materialise—it was a fiction. The psychosocial dimensions and its normative implications call the concept of identity into question. Instead it is advisable to speak of a pychoanalytic attitude which has to prove its therapeutic value. This “second (professional) self” (Schafer 1983) is closely connected to the “first (personal) self”, but it is necessary and possible to separate the method from the person and to objectify changes in the patient even if taking place in an intersubjective, relational space. For many years Freud defined what Psychoanalysis is about and who is entitled to call himself an analyst. Later on, the psychoanalytic movement and the institutionalised training system fulfilled this role. The training analysis had been at the centre of all curricula. The genealogy of the training analyst determined the membership in the evergrowing family. Dissidents belong to the history of Psychoanalysis. The official acceptance of the pluralisms within the International Psychoanalytical Association demands comparisons between the various schools according to scientific criteria. Modern process and outcome research provides criteria suited to serve as a model for clinical treatment reports.     

On the astonishing clinical irrelevance of neuroscience

The clinical work of psychoanalysts can be thought of in both a narrow and a broad sense. In the narrow sense, it refers to what is commonly thought of as psychoanalytic technique, the methods analysts use to understand their patients and to convey that understanding to them. In the broad sense, it refers to the entirety of their work as clinicians: the content of understanding, as well as such things as diagnosing, estimating analyzability, recommending therapy, and prescribing medication. The current enthusiastic expectation that neuroscience will have an immediate and direct impact on clinical work in the narrow sense is misguided, but neuroscientific discoveries, it is argued, will have a major impact on psychoanalytic theory in the not too distant future. The resulting changes in metapsychology will ultimately have reverberations on clinical work in the broad sense, although psychoanalytic technique, the analyst's basic approach to patients, will remain essentially the same.     

'My capital secret': Literature and the psychoanalytic agon

Taking as my departure point Freud 's unequivocal claim in The Question of Lay Analysis that psychoanalytic education should include "the history of civilization, mythology, the psychology of religion, and the science of literature" ( Freud, 1926b, p . 246), I advocate for an integration of psychoanalysis with the arts, the humanities, and the social sciences in psychoanalytic training. Foundations in these fields are not only acceptable as preliminary to clinical training but will also provide the diverse intellectual climate that is urgently needed in psychoanalytic institutes whose discursive range is often quite narrow. To provide one example of the salutary effect of such disciplinary integration on clinical practice, I illustrate how the transformative power of literature provides compelling metaphors for the psychoanalytic encounter. Through an example drawn from within my own experience as literary critic and psychoanalyst, I describe the ways that the troubling tensions in Milton's Samson Agonistes functioned to illuminate, for me, an analysand 's 'capital secret'.     

Toward a tripartite vision of supervision for psychoanalysis and psychoanalytic psychotherapies: alliance, transference-countertransference configuration, and real relationship

The psychoanalytic supervision relationship is examined as a tripartite phenomenon, comprised of the supervisory alliance, transference-countertransference configuration, and real relationship. While most supervisory analysts would readily acknowledge that a real (or personal) relationship element exists in analytic supervision, that facet of the supervision relationship has not routinely been incorporated into considerations of psychoanalytic supervision. In this vision of supervision, real relationship, supervisory alliance, and transference-countertransference configuration are presented as integral and complementary constructs that define psychoanalytic supervision. Each of those three components is examined briefly with regard to its beginnings, evolution, and contemporary status; each component is also considered from an empirical perspective. While we have a growing quantitative and qualitative research foundation that supports psychoanalytic practice, psychoanalytic supervision has largely been ignored as a subject and object of scientific study. Supervisory alliance, transference-countertransference configuration, and real relationship are explored as research ready variables. Some clinical hypotheses--eminently testable and worthy of investigation--are proposed with regard to each component of the model, and some ideas--albeit tentative and preliminary--about how to initiate such inquiries are offered.     

Goal Theories of Motivation as Rigorous Humanism

Over the past few decades, there has been increasing interest among social, clinical, and personality psychologists in the topic of human agency in general and personal goals in particular. Goal theories of motivation are described and analyzed from the perspective of Rychlak's rigorous humanism. Studying goals may actually be more of a methodology than a theory. A number of different theories could lead to the study of goals as a primary research methodology. However, not all such theories will meet Rychlak's criteria for rigorous humanism. The role of goals in Logical Learning Theory is discussed.     

Access to psychoanalytic ideas in American undergraduate institutions

To determine the prevalence of teaching about psychoanalytic ideas in the undergraduate curricula of 150 highly ranked colleges and universities, a software-based search was conducted to find references to psychoanalytic content in published course catalogues. Results showed that psychoanalytic ideas were represented somewhere in the curricula of most (though not all) of these schools, and that overall there were many times more courses featuring psychoanalytic ideas outside psychology departments than within them. The data also suggest that there are regional differences in the likelihood an undergraduate will encounter psychoanalytic ideas at these schools. Though psychoanalytic ideas are available in some form in most of these schools' psychology departments, the average number of courses per school is small. At the same time, psychoanalytic ideas have found applications in many areas of the humanities and social sciences. The nature of the presentation of psychoanalytic ideas in these areas, however, may often be unfamiliar to clinically oriented analysts, as seen in examples of the courses that were found. Challenges and opportunities of the current academic climate vis-à-vis organized psychoanalysis are described and various suggestions made regarding how analysts can engage the academic world to its benefit.     

In Progress … I Hope: From Pediatrics to Psychoanalysis to …

Psychoanalysis must be an idiosyncratic matter. That means that the encounter between the patient and the analyst is carried out through the personal character of both participants. But there is something more. Historical and cultural patterns are also most influential. The present and the past social context where the psychoanalytic bipersonal meeting occurs is a significant factor in the evanescent constitution and the constant movement between the ego of the analyst and the ego of the patient. Therefore, in this radical view only Freud would fulfill a Freudian encounter. We, as probable post-Freudians, must be permanently searching for personal, idiosyncratic ways in the clinical work. Brazilian psychoanalysts face the challenge to treat their patients in a Brazilian way. To understand Brazilian people and the way psychoanalysis may develop in this land, we must know that Brazilians' lived experience is frequently blended by irony, paradox, and the fleeting character of the human life. Words—a pragmatic perspective of Brazilian words in action—are essential for the task. Interrogative psychoanalytic dialogues are my main topic of research.     

Becoming an Individual: Technically Subversive Thoughts on the Role of the Analyst's Influence

One of the most controversial issues in discussions of how psychoanalytic treatment “works” has been understanding the place and proper influence of the analyst's unique individuality on the process, and, in the terms framed in this paper, on the actual shaping of the patient's mind. This paper suggests that one reason this problem has endured is the absence of a framework for understanding how the analyst, as a unique individual with an inextricable personal mind, is key to the repair of the patient's impaired sense of agency and, as a consequence, the actual reconfiguration of the patient's mind. The paper argues that this personal process is not an unfortunate inevitability, but, like the developmental impact of the unique individuality of parents, represents an essential element, perhaps the core, of what enables real change and growth.     

‘Mr K’ – A successful case of analytic oriented therapy documented empirically: the role of the therapeutic relationship and reflexive self-awareness

A successful case of analytic treatment over the course of 250 sessions is described from different perspectives, including considerations from the two-year follow-up. The therapeutic alliance and the patient’s experiencing were evaluated. Pre-treatment diagnosis was validated via diagnostic interview. Symptoms and interpersonal problems were assessed at intervals. Data were analysed using two different time-series analyses. Aspects of agency with regard to mentalizing capacity were assessed with the Metacognitive Assessment Scale. We obtained the following main results: (1) Symptoms and interpersonal problems improved continuously until the end of treatment. Symptom severity fell to below the clinical cut-off. This successful outcome remained stable at the two-year follow-up. (2) The therapeutic relationship improved during the therapeutic process. (3) The patient’s capability for reflexive self-awareness, operationalized as experiencing, decreased. (4) The metacognitive mastery of the patient increased. The following conclusions were made after combining the empirical data with the clinical observations: (1) Mr K improved clinically in terms of symptoms, self-regulation and interpersonal problems as a result of his gaining affect control. (2) The patient’s experiencing does not capture a positive outcome in all cases. (3) Aspects of agency (i.e. metacognitive mastery) deserve further attention in psychoanalytic treatments.     

Classification of adult attachment: an integrative taxonomy from attachment and psychoanalytic theories.

Developmental and psychoanalytic theorists have focused increasingly on empirically determined early childhood antecedents of adult attachments, with several resulting taxonomic models. This article suggests a theoretically based and clinically based model of attachment consistent with both psychoanalytic and attachment theories, resulting in an integrative taxonomy of four adult attachment styles: dependent, avoidant, hostile, and resistant-ambivalent. These styles reflect behavioral manifestations of dependence and anger, as derived from the interaction of primitive relational drives, defenses, and interpersonal experience. In addition to theoretical construction, brief clinical examples are presented to facilitate discussion of the model.     

Introduction Voices The Editors

Postmodern theory and critiques currently exert a considerable influence on psychoanalytic theory, particularly in regard to the revision of a theory of sexuality and gender. This article reviews some of the critiques and alternative views of sexuality proposed by various postmodern theorists such as Butler, Jameson, Baudrillard, and Foucault. After conducting a critical comparison of these critiques and alternatives with contemporary analytic revisionist theory, I contend that, despite the useful aspects of postmodernism's critical cultural perspective, some postmodern positions run directly counter to certain key psychoanalytic tenets about human agency and the existence of an inner psychic world or selfhood. Furthermore, I believe that, despite the laudable politics of many postmodern writers to promote a greater diversity of nonpathologized sexual experience, the atrophied views of agency and selfhood depicted in the postmodern writings reviewed in this essay cannot support an approach that is concerned with clinical treatment or with describing processes of psychological transformation. A case vignette is provided illustrating the main arguments of the paper.     

The Coparticipant Field: Commentary on a Paper by Juan Tubert-Oklander

Psychoanalytic field theory is integral to relational praxis. In his study of the analytic field and its interpersonal complexities and relational intricacies, Tubert-Oklander emphasizes its clinical promise. Tubert-Oklander's field orientation, however, is a conservative and limited one. This commentary proposes a new, more radical coparticipant theory of analytic praxis.

As a unique form of clinical participation, coparticipant inquiry is marked by an emphasis on patients' and analysts' relational mutuality, coequal analytic authority, and dyadic uniqueness. Coparticipant inquiry represents both a one-person and two-person psychology—an integral of classical individualism and the social emphasis of the interpersonal/relational viewpoint. Coparticipant analysis calls for a new, multidimensional concept of the self that reconciles the seeming paradox that we are simultaneously communal and individual beings—from birth embedded in a series of social field, yet always uniquely individual. This psychoanalytic dialectic between personal, nonrelational selfic “I” processes and an interpersonal “me” pattern brings into relational play such concepts as will, self-determination, and agency. Coparticipation promotesatechnically freer, more self-expressive, and spontaneous inquiryandemphasizesthecurativeimmediacyofnewrelationalexperience.

I have believed for a long time that human

nature is a reciprocity of what is inside the skin

and what is outside; that it is definitely not

“rolled up inside us” but our way of being one

with our fellows and our world. I call this field

theory.

—Gardner Murphy     

An overview of the treatment of severe narcissistic pathology

This paper provides an overview of narcissistic personality disorders as they present clinically along a spectrum of severity ranging from the best functioning forms of pathological narcissism to the most threatening to the patient's psychosocial and physical survival. It proposes a general interpretive psychoanalytic stance with all these clinical syndromes that range from standard psychoanalysis to a specific psychoanalytical psychotherapy for the most repressive and life threatening conditions that may not respond to standard psychoanalysis proper. This general psychoanalytic approach is placed into the context of related developments in contemporary psychoanalytic understanding of pathological narcissism and its treatment.     

"Why is it that I see everything differently?" Reading a 1933 letter from Paula Heimann to Theodor Reik

A letter from Paula Heimann to her training analyst, Theodor Reik, written shortly before her emigration from Berlin to London, sheds light on some of the technical controversies and personal animosities that shaped psychoanalytic clinical discourse in the early 1930s, as well as on Heimann's subsequent development as a clinician. A close reading of this letter highlights several distinctive aspects of psychoanalytic training and demonstrates the transgenerational transmission of psychoanalytic ideas.