A HISTORICAL REPRISE: SOME OBSERVATIONS ON PROGRESS IN PSYCHOANALYSIS

The papers from the American Journal of Psychoanalysis 1956 and 1965 roundtables on what is effective in the therapeutic process are viewed through the lens of psychoanalysis’ evolution over the past 50–60 years. With the passage of time, the contributions of the Interpersonal School to mainstream psychoanalysis have become clearer, especially with respect to mutative factors in the patient-analyst relationship. These papers from the 50s and 60s are also products of the internecine battles of the time, in which the different schools of psychoanalysis tried to claim absolute truth and assert hegemony in the field. The author argues that real progress in psychoanalysis has occurred through research and clinical/theoretical discovery, yielding an informed pluralism that mirrors the diversity and complexity of our work with patients.     

The psychoanalytic process: motives and obstacles in the search for clarification

One motive for regarding psychoanalysis as a "process," and for attempting to define its exact nature, is to enable analysts to clarify their criteria for distinguishing authentic psychoanalysis from other therapies that resemble it or are derived from it. In the present climate of theoretical pluralism, any list of defining qualities that could win wide acceptance would of necessity be cast in terms of such general quality as to limit its utility as a precise template. Another motive for holding on to the "process" concept arises from the unpredictable nature of analytic progress in even the most satisfactory cases.     

How wide is the widening scope of psychoanalysis and how solid is its structural model? Some concerns and observations

The author advances the thesis that in the past 35 years there has been a relatively silent but nonetheless significant movement within the mainstream of American psychoanalysis toward a more "modest" position. This movement has been stimulated from different sources, sometimes with diverse goals and different programs. One determinant was the reaction to the post-World War II euphoria in regard to psychoanalysis and its possible therapeutic powers. Another element has been the ongoing consolidation of our knowledge and understanding of the ego-psychological, structural-model approach to analytic theory and technique, an approach which emphasizes both intrapsychic conflict and compromise formations. A consequence of this more modest position has been a greater appreciation of the limitations of psychoanalysis as well as the significance of those limitations. This more realistic appraisal of psychoanalysis may not have encouraged the widening scope of the indications for analysis, but the enhanced understanding of its limitations offers the promise of more effective psychoanalytic work in areas that have not been considered ideal for the so-called "traditional" analysis. It is suggested that more sophisticated approaches in the analysis of resistance and character, of "conflict" (in distinction to "diagnoses"), together with a more applicable understanding of the psychoanalytic process, can all contribute to a deepening, if not necessarily widening, of our psychoanalytic endeavors.     

Combined Group and Individual Psychoanalysis: An Antidote to Ferenczi's Identification with the Aggressor

Ferenczi's recommendations that analysts not only listen to their patient's criticisms but encourage them to be so bold as to speak up when they disagree is facilitated in a combined group and individual psychoanalysis. Because group analysis occurs in the presence of others and with the participation of others, it acts as a protection against an identification with the aggressor that can occur when the therapeutic dyad is isolated from outside influence. Case examples from a combined psychoanalysis as well as a combined supervision are given to demonstrate these points.     

Translating child analysis from the playroom to the classroom: opportunities and choices

Over the years, psychoanalysts and educators have made efforts to meld a psychoanalytic orientation with the education of young children. The resulting programs have variously been called psychoanalytic nurseries, therapeutic nurseries, therapeutic preschools, or psychoanalytic early childhood programs. The methodology of the application or integration of psychoanalysis with the education of young children has received relatively little attention. After a brief historical review of the application of psychoanalysis to helping children in group educational settings, a number of features common to programs integrating psychoanalysis and early childhood education are described. A specimen program is next presented in which an application of psychoanalysis is used to assist children whose development is proceeding in a psychopathological direction. Also demonstrated are various ways in which psychoanalysis may be adapted to such programs, some options involved, and the capacity, realized and potential, for work within a therapeutic nursery to expand the field of inquiry and the therapeutic action of child analysis as conducted within a traditional framework.     

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     

On the fate of psychoanalysis and political theory

The author explores the present structure of the relationship between psychoanalysis and political theory, finding that the two often attempt to integrate each other's findings as mere resources within the pursuit of fundamentally self-determined projects. This radically misconstrues the force and meaning of the insights upon which they draw. Especially when psychoanalytic interpretations of collective subjects (nations, regions, etc.) occur, the relationship between psychoanalysis and political theory may not be appropriately mediated, promoting suspiciousness about the interpretive and therapeutic efficacy of such nonclinical "interventions." The author proposes an alternative paradigm for a new working relationship between psychoanalysis and political theory.     

Editorial

This paper discusses contraindications to psychoanalysis and psychoanalytic training. From Freud onwards, there has been a clear understanding that not all patients are helped by psychoanalysis, but there has been considerable controversy as to who might benefit from treatment, and whether this depends on the diagnosis, the personality or the rather vague concept of “analysability". Increasing emphasis has been placed on the analyst-patient relationship and its characteristics, without this clearly solving the dilemma. Moreover, while psychoanalysis was previously perceived rather uniformly in its classical version, treating mainly neurotics, increasing differentiation between psychoanalytic schools has appeared in the last fifty years, which would seem to give grounds for a widening of indications. This development has increased the need for rational criteria for indications and contraindications. In this article, research findings relating to outcome and process and the therapeutic relationship will be examined in parallel with clinical experience. As the therapeutic relationship is probably decisive for the outcome of the treatment, scrutiny of who is suited to be a psychoanalyst should have been an important focus of research. This has not been the case. Available research on this issue and the experiences of practitioners in the evaluation of candidates will be discussed in the following.     

A training analysis for psychoanalytic psychotherapists

For historical reasons, psychoanalytic psychotherapy has been regarded as a second-class treatment in comparison with psychoanalysis, and standards for training in it have lagged behind those for psychoanalysis. However, psychoanalytic psychotherapy is the treatment of choice for many healthier (or higher-level) patients who cannot receive analysis for any reason, and also for a large population of more-disturbed patients who are not appropriate for psychoanalysis. Mastering techniques of psychoanalytic psychotherapy may be as difficult as mastering those of psychoanalysis, and should require comparable theoretical training, supervision, and personal treatment. This "development lag" in the training of psychoanalytic psychotherapists has taken place for several reasons: (1) Psychoanalytic ideas first emerged in America in the context of a new movement toward an electric, but dynamic psychiatry from which psychoanalysis had to establish its separate identity. (2) Psychotherapy was associated with techniques of suggestion and manipulation from which psychoanalysis wished to separate. (3) Because psychotherapy was seen as an inferior form of therapy which required little training, institutes were slow in being established, and reluctant to require a "training analysis." It is suggested that with the full training of psychoanalytic psychotherapists, this discipline may be regarded as a profession comparable to psychoanalysis. It is further suggested that the optimal treatment for the full training of the psychoanalytic psychotherapist is psychoanalysis, and that a "training psychotherapy" is not an adequate substitute, but may provide a transitional step to resolve initial resistances and to prepare the therapist for a training analysis.     

The enduring presence of Heinz Kohut: empathy and its vicissitudes

This paper expands upon and further develops the centrality of empathy in psychoanalysis as offered by Heinz Kohut. Using clinical examples, it differentiates sustained empathy as the distinctive component of psychoanalysis, and it demonstrates some of the difficulties in determining the boundaries of empathy in the practice of psychoanalysis. A further distinction is from mind reading, a purely cognitive exercise, as is intuition (Carruthers 2009). To pursue a psychoanalytic perception of empathy one must confront its limitations and go beyond the somewhat simplistic claim of its unquestioned therapeutic effect. Empathy is more than a cognitive act, and as sustained over time it can be difficult to achieve, can be misunderstood, and can at times have no therapeutic effect.     

Losing a father all over again: the termination of an analysis of an adolescent boy suffering from father loss

Criteria for beginning and conducting the termination phase of psychoanalysis have provoked debate and confusion from the early days of psychoanalysis. Gabbard (2009) has recently pointed to the field's tendency to cling to idealized versions of these criteria as a way to deal with disagreements. The situation becomes more complicated for child and adolescent psychoanalysts because their patients are in the midst of a developmental process at the very time they are engaged in a psychoanalytic process. The termination phase of an adolescent male suffering from father loss is presented in depth in order to provide clinical data toward further consideration of the vexing questions surrounding termination in psychoanalysis. His termination is used to examine the relative importance of losing the analyst as a transference object as against a developmental object; the meaning of action during termination; the complicating role of trauma vis-à-vis termination; and the importance of the post-termination phase of analysis. It is suggested that his termination phase demonstrates that a "good enough" termination involves the development of a self-analyzing capacity that continues to evolve and develop after termination.     

Ethical Presence in the Psychoanalytic Encounter and the Role of Apology<Superscript>*</Superscript>

This paper discusses aspects of ethical presence in psychoanalysis, and the possible use of apology in the therapeutic process. The author roughly delineates two periods in the history of psychoanalysis regarding the ethical dimension—the early classical period which is influenced by Freud’s ethics of honesty, which gradually evolves towards the more recent intersubjectively-influenced period, necessitating the assimilation of an ethics of relationships. It is suggested that explicit theorizing of the ethical dimension into psychoanalysis offers added value to its effectiveness, and a framework is presented for combining relational, intersubjectively informed ethical dialogue, with contributions of classical technique, enriching the therapeutic potential of psychoanalytic work.     

Strategic self-marginalization: the case of psychoanalysis

Marginality is an important concept in the history of science, though it is often used in a manner that presumes marginality to be a static designation. We contend that the dynamics of marginality are crucial to the history of psychoanalysis, a discipline that has moved between dominant and marginal positions. We address psychoanalytic marginality via three specific "cases": the marginalization among Freud and his followers when psychoanalysis was an emergent discipline; the marginality trope in Erich Fromm's popular psychoanalytic writing when psychoanalysis was orthodoxy in American academic psychiatry; and the rhetorical marginality of psychoanalysis in Sweden as psychoanalysis entered a decline within psychiatry. Our aim is to show that marginalization and self-marginalization serve interpersonal, social, and professional strategies.     

Psychoanalytic Healing,Love, Life,and Death: Commentary on Paper by Sheldon Bach

In his seminal clinical writings on psychoanalysis, Sheldon Bach transcends the limiting confines of individual and parochial schools of psychoanalysis. Both in “On Digital Consciousness” and in his 2006 Getting From There to Here: Analytic Love, Analytic Process, we see a strong relational dimension in Bach's work (see also Bach 1985 Bach, S. 1985. Narcissistic states and the therapeutic process, Northvale, NJ: Aronson.  [Google Scholar] and 1994), though he comes from firmly within the psychoanalytic mainstream. Bach's writings speak to clinicians across schools of thought, are clinically near to experience and are often moving. While he makes occasional mention of his contemporaries, Bach is grounded in more traditional references and only hints at his intellectual connection to relational and intersubjective theorists. One purpose of this commentary is to reflect on Bach's contribution to contemporary psychoanalysis and to draw out the connections between his work and the work of those within the broader relational and intersubjective community of psychoanalysis.     

Towards a common ground in psychoanalysis and family therapy: on knowing not to know

In this paper a common ground between psychoanalysis and family therapy is discussed in terms of postmodern theorizing in both disciplines. Recent systemic, narrative or social constructionist thinking in psychoanalysis and a psychoanalytic turn in family therapy offers the possibility of a shared epistemology. This is described in terms of a critical not-knowing stance which allows for the therapist's/analyst's contribution of meaning, interpretation and knowledge in therapeutic conversation. Here the holding of not knowing and knowing together provides a narrative container for personal meaning and thinking to develop. This 'knowing not to know' is what a postmodern psychoanalysis has in common with family therapy: both are ways of being with persons to help them develop and hold their own knowing. This therapeutic process is illustrated in a clinical vignette of narrative child family therapy.
For what one knows does not belong to oneself.
(Marcel Proust, Remembrance of Things Past , p. 898)     

The analyst's knowledge and authority: a critique of the "new view" in psychoanalysis

A critical assessment is presented of positions recently taken by Mitchell and Renik, who are taken as representatives of a "new view" in psychoanalysis. One article by Mitchell and two by Renik are examined as paradigmatic of certain ways of construing the nature of mind, the analyst's knowledge and authority, and the analytic process that are unduly influenced by the postmodern turn in psychoanalysis. Although "new view" theorists have made valid criticisms of traditional psychoanalytic theory and practice, they wind up taking untenable positions. Specifically called into question are their views on the relation between language and interpretation, on the one hand, and the mental contents of the patient on the other. A disjunction is noted between their discussion of clinical material and their conceptual stance, and their idiosyncratic redefinitions of truth and objectivity are criticized. Finally, a "humble realism" is suggested as the most appropriate philosophical position for psychoanalysts to adopt.     

Zeit und Zeitlosigkeit der Psychoanalyse

Time is a central category of psychoanalysis and a differential criterion against other forms of psychotherapy. The polarity of time and timelessness moulds not only the most important analytic notions, but the treatment too. Treatment means work in and on time and means production of the past. In the timeless, fulfilling moment of interpretation, of insight and emotional experience the therapeutic process is condensed to the time of the psychoanalysis. The close connection between time experience and early relationship experience is elaborated along the history of development and thereby, the relevance of integrable deprivations is highlighted. Thus, it is not surprising that psychopathologies are also time pathologies. Psychoanalysis should be the advocate of the experience of time against the increasing acceleration of life.     

Elasticity of Technique: The Psychoanalytic Project and the Trajectory of Ferenczi's Life

The object of this paper is the Elasticity of Psychoanalytic Technique in the work of Sándor Ferenczi. The author sustains that this can be considered neither as an ultimate arrival point nor as a particular stage of Ferenczi's clinical–theoretical body of work, but rather as an ensemble of affective qualities, attitudes and values, which he gradually developed through experience, signalling a paradigm shift in the history of psychoanalysis. The following areas will be explored: the new sensitivity demonstrated by Ferenczi concerning the relational and communicative factors present in the analytic session, his subtle and acute attention to the participation of the analyst's own subjectivity in the therapeutic process, and how these enduring elements of Ferenczi's technique anticipate several significant future developments in psychoanalysis.     

Controversies and Conflicts in the Institution of "Open" Psychoanalysis: Cases from the History of the Therapeia Foundation

The institution of psychoanalysis has included controversies, dissensions and expulsions at both the theoretical-methodological and personal-organizational levels. There have also been several intra- and intergroup conflicts in the history of psychoanalysis, and in constructing and patterning the future of psychoanalytic knowledge. In the context of Finnish psychoanalysis, the Therapeia Foundation (founded in 1958) met from the start with resistance from official psychiatry and also from the IPA. For example, in the mid-1960s, D. W. Winnicott, as the President of the IPA, supported the orthodox Finnish psychoanalytic study group (later to become the Finnish Psychoanalytical Society), and pronounced that the Therapeia group was too loose and was not strictly able to use the IPA-recognized designation "psychoanalytic." The Therapeia Foundation and its Training Seminar combined classical psychoanalysis and its new versions with existentialphenomenological views, anthropological medicine, research on "social pathology" and even modern theological research. On the basis of their Swiss analytic training, three Finnish psychiatrists, Martti Siirala, Kauko Kaila and Allan Johansson, organized Therapeian training to incorporate sciences and arts, and skills involving the therapeutic "carrying" of burdens. The multifacted nature of open psychoanalysis was seen to find its proper organizational expression when the Training Seminar of the Therapeia Foundation became, in 1974, a Member of the IFPS.