On psychoanalytic autobiography

This article considers how one might define ‘psychoanalytic autobiography’, using statements from theorists of ‘life-writing’ and extracts from autobiographers (some of them psychoanalysts), together with their own commentaries on the genre. The focus is less on content and more on the nature of the art form, with a view to noting analogies with the psychoanalytic process. These analogies are to be found, in particular, in the qualities of transference dialogue; in the art of transformative or communicative projective identification; and in the contrast between self-indulgent and constructive types of memory. Psychoanalytic autobiography is seen as a mode of remaking the self – not omnipotently but through exploratory self-analysis, frequently following the familiar pattern of loss and rediscovery. It entails a special imagined relationship with the unknown reader, and a sense of being guided by a detached observational eye equivalent to that which Bion terms the ‘third party’ in a psychoanalytic situation.     

Dream actors in the theatre of memory: Their role in the psychoanalytic process2

The author notes that neuropsychological research has discovered the existence of two long‐term memory systems, namely declarative or explicit memory, which is conscious and autobiographical, and non‐declarative or implicit memory, which is neither conscious nor verbalisable. It is suggested that pre‐verbal and pre‐symbolic experience in the child's primary relations is stored in implicit memory, where it constitutes an unconscious nucleus of the self which is not repressed and which influences the person's affective, emotional, cognitive and sexual life even as an adult. In the analytic relationship this unconscious part can emerge essentially through certain modes of communication (tone of voice, rhythm and prosody of the voice, and structure and tempo of speech), which could be called the ‘musical dimension’ of the transference, and through dream representations. Besides work on the transference, the critical component of the therapeutic action of psychoanalysis is stated to consist in work on dreams as pictographic and symbolic representations of implicit pre‐symbolic and pre‐verbal experiences. A case history is presented in which dream interpretation allowed some of a patient's early unconscious, non‐repressed experiences to be emotionally reconstructed and made thinkable even though they were not actually remembered.     

Die tiefenpsychologisch fundierte Methodik in der Praxis

Depth psychologically founded psychotherapy (tfPT) is historically a method derived from psychoanalysis. It was introduced in 1967 into the scope of psychotherapy in Germany by the Psychotherapy Guidelines and has developed since then a certain autonomy. This contribution describes its methodical basis and its practical application in the context of the Psychotherapy Guidelines in Germany. A standard tfPT method for the treatment of neurotic conflict disturbances is distinguished from the modified tfPT for the treatment of developmental disturbances and posttraumatic disorders. The method is defined by several characteristics in this paper: Current psychosocial problems of the patients are worked through as re-actualised conflicts or results of structural deficiencies in their actual genetic unconscious dimension. The uncovering and working through of transference in external relationships is of special importance. The therapeutical regression is limited by the setting (one encounter per week in vis-a-vis position, limitation to 50 up to 80 sessions in total), by focusing on the psychosocial reality and by restriction of the transference. Specific intervention forms, particularly interpretations, can be combined with structure oriented interventions or eclectic techniques. The orientation at the unconscious dimension of the disturbance and at the process is the central reference point of the complete therapeutic strategy. This definition allows a clear demarcation against psychoanalytic psychotherapy. The essential difference is to be seen in the focusing on the re-actualised elements of the relevant psychodynamics and in including the external relationships into transference (“Dezentrieren”). The specific methodology requires a special education with a depth psychologically founded self experience as its core.     

TRANSFERENCE BEFORE TRANSFERENCE

This paper is predominantly a clinical presentation that describes the transmigration of one patient's transference to another, with the analyst functioning as a sort of transponder. It involves an apparently accidental episode in which there was an unconscious intersection between two patients. The author's aim is to show how transference from one case may affect transference in another, a phenomenon the author calls transference before transference. The author believes that this idea may serve as a tool for understanding the unconscious work that takes place in the clinical situation. In a clinical example, the analyst finds himself caught up in an enactment involving two patients in which he becomes the medium of what happens in session.     

Making Interpersonal Meaning: Significant Others in Mind in Transference

The social cognitive process of transference may serve as a means of constructing interpersonal meaning. Support for this proposition is presented through a review of evidence on the relational self in transference, reframed in terms of meaning construction, as well as new investigations of the ways precise ways in which transference can serve this function. In the underlying theory, knowledge one has about each of the various significant others in one’s life is represented in memory and linked to a distinct relational self in memory by means of the relationship with that other. Significant‐other knowledge can be activated in an interpersonal encounter and, when transference occurs, used to go beyond the information given about a new person and also influences affect, motivation, and self‐regulation ( Andersen & Glassman, 1996 ). Distinct relational selves also arise in transference depending on which significant other is triggered by the situation. These processes allow the individual to imbue the interpersonal encounter with personalized meaning. Further, recent evidence suggests that whole meaning systems shared with the significant other are constructed in that relationship and are thus evoked and pursued in the transference encounter.     

MAPPING THE LANDSCAPE: LEVELS OF TRANSFERENCE INTERPRETATION3

The author argues that there are distinctly different kinds of transference interpretation, each of which might be valid in particular circumstances in analysis, but which contain and imply different understandings of what is meant by a ‘transference interpretation’. She suggests that transference interpretations may be at any one of four different levels, and she describes these levels as ranging from interpretations that point to links between current events in the analysis and events from the patient's history, through interpretations that link events in the patient's external life to the patient's often unconscious phantasies about the analyst and the analysis, to interpretations that focus on the use of the analyst and the analytic situation to enact unconscious phantasy configurations, sometimes pulling the analyst into the enactment. Material from four consecutive sessions of an analysis is presented to illustrate how all levels of transference interpretation may be part of a lively and meaningful analysis, but how the level of interpretation may change as the level of understanding deepens within a session and from one session to the next.     

Transference: current concepts and controversies

In this paper I have presented a brief outline of some of the more important issues regarding transference. To summarize I shall restate ten transference issues heretofore discussed: What should be included in the definition of transference? Should it be defined narrowly or broadly? In what ways can transference be usefully viewed in relation to reality? What merit is there in distinguishing the working alliance from transference? Should self and object transference be differentiated? Should transference neuroses be discriminated from transference reactions on the one hand and from transference psychoses on the other? In addition to sexual and aggressive transferences, should sexualized and aggressivitized transferences, respectively, be distinguished? How may transference be conceived of as a vehicle of cure and yet also as a resistance to cure? What is to be said for the relative merit of the "here and now" versus the "there and then?" What is the role of transference in relation to insight on the one hand and to the therapeutic object on the other? What are some of the basic issues in countertransference?     

The child dream and the child transference

This paper explores the symbolic meaning of dreams in which children appear with special attention to the way children in dreams symbolize the self, particularly the dependent and developing self. It is suggested that patients' growth in analysis can be monitored by observing what happens to the children in their dreams. This paper also explores the vicissitudes of the child transference, in which the patient treats the analyst as a child. An analysis is described in which the child dream and the child transference played an important role in elucidating the patient's neurotic behaviors. The author contends that the child dream and the child transference are common and clinically useful phenomena, especially important in the analysis of dependency conflicts. An additional thesis of this paper is that the child transference is most likely to be found in instances where a patient played a parental role with one of their parents during childhood.     

Preconscious defence analysis, memory and structural change

Beginning with the ways in which the use of the couch lends 'depth to the surface' (Erikson, 1954), I explore the topography of the inter - and intra subjective psychoanalytic situation and process. I suggest that defences are not by definition unconscious but rather can be observed operating at conscious and preconscious levels, particularly under these conditions. A focus on preconscious disavowal provides a window on what has become unconscious repression. As a result of eliciting and then verbalising the operation of such defences with regard to anxieties in the here-and-now transference, declarative memories of increasingly specific childhood fantasies and events begin to hold sway over unmanageable procedural remnants from the analysand's past. With this may even come the possibility of neuronal regeneration, the more generalisable enhancement of declarative and symbolic functions and the sense of identity with which these are associated. Herein may lie one enduring therapeutic effect of the 'talking cure' - putting feelings into words - as one among a variety of psychotherapeutic modalities.     

Playing and working through: a neglected analogy

The author proposes an analogy between certain features of playing and aspects of working through. Conceptualizing psychoanalysis as the process whereby unconscious fantasy is uncovered and then subjected to rigorous scrutiny, and building on Freud's (1908) insight that play is the same as fantasy--with the essential difference that fantasy links itself to real objects in play, such as toys and playthings--the author proposes that play can be thought of as not merely symbolic, as a fantasy bearer, so to speak, but as a fantasy tester as well. In the process of working through, some analysands attach their unconscious fantasies not only to a transference object, a primary libidinal object, or a significant loved one, but also to actual props within the analytic setting (a Kleenex box, for example), making the analogy with play even more obvious and palpable.     

Bearing the unbearable: ancestral transmission through dreams and moving metaphors in the analtyic field

Abstract: This paper explores how untold and unresolved intergenerational trauma may be transmitted through unconscious channels of communication, manifesting in the dreams of descendants. Unwitting carriers for that which was too horrific for their ancestors to bear, descendants may enter analysis through an unconscious need to uncover past secrets, piece together ancestral histories before the keys to comprehending their terrible inheritance die with their forebears. They seek the relational containment of the analytic relationship to provide psychological conditions to bear the unbearable, know the unknowable, speak the unspeakable and redeem the unredeemable. In the case of ‘Rachael’, initial dreams gave rise to what Hobson (1984) called ‘moving metaphors of self’ in the analytic field. Dream imagery, projective and introjective processes in the transference‐countertransference dynamics gradually revealed an unknown ancestral history. I clarify the back and forth process from dream to waking dream thoughts to moving metaphors and differentiate the moving metaphor from a living symbol. I argue that the containment of the analytic relationship nested within the security of the analytic space is a necessary precondition for such healing processes to occur.     

Finding unconscious phantasy in the session: Recognizing form

The concept of unconscious phantasy has played – and still does play – a central role in psychoanalytic thinking. The author discusses the various forms by which unconscious phantasies manifest themselves in the analytic session as they are lived out and enacted in the transference relationship. This paper also aims at expanding the kleinian theory of symbol formation by exploring the impact that emotional aspects connected to early “raw’, “pre‐symbolic’ phantasies have in the analysis and how their corporeal elements interlock with the signifying process. The author follows the expressive forms of primitive unconscious phantasies as they appear in a psychoanalytic session and proposes that the emotional effect that can be experienced in the communication between patient and analyst depends in great measure on “semiotic’ aspects linked to primitive phantasies that are felt and lived out in embodied ways. Rather than a move from unconscious phantasies that typify symbolic equations to those showing proper symbolization, these can coexist and simultaneously find their way to what is communicated to the analyst. As early phantasies bear an intimate connection to the body and to unprocessed emotions when they are projected into the analyst they can produce a powerful resonance, sometimes also experienced in a physical way and forming an integral part of the analyst's counter‐transference.     

The dynamics of interpretation

The patient's productions are a dynamic record of the conflicts of the past as they are recapitulated and re-experienced in the present. Much can be learned by closely studying the immediate effect of the analyst's interventions. Interpretation, especially of transference phenomena, will upset the equilibrium which has been effected and will enable the patient to understand how unconscious fantasies from the past continue to influence his perception and reactions in the present. Interpretation is a continuing process, unfolding in logical sequence. Transference may be an expression of the patient's resistance to recognizing an unconscious wish toward the original object.     

Mentalization, insightfulness, and therapeutic action The importance of mental organization

Continuing debates over the relative importance of the role of interpretation leading to insight versus the relationship with the analyst as contributing to structural change are based on traditional defi nitions of insight as gaining knowledge of unconscious content. This defi nition inevitably privileges verbal interpretation as self‐knowledge becomes equated with understanding the contents of the mind. It is suggested that a way out of this debate is to redefi ne insight as a process, one that is called insightfulness. This term builds on concepts such as mentalization, or theory of mind, and suggests that patients present with diffi culties being able to fully mentalize. Awareness of repudiated content will usually accompany the attainment of insightfulness. But the point of insightfulness is to regain access to inhibited or repudiated mentalization, not to specifi c content, per se. Emphasizing the process of insightfulness integrates the importance of the relationship with the analyst with the facilitation of insightfulness. A variety of interventions help patients gain the capacity to refl ect upon and become aware of the intricate workings of their minds, of which verbal interpretation is only one. For example, often it seems less important to focus on a particular confl ict than to show interest in our patients’ minds. Furthermore, analysands develop insightfulness by becoming interested in and observing our minds in action. Because the mind originates in bodily experience, mental functioning will always fl uctuate between action modes of experiencing and expressing and verbal, symbolic modes. The analyst's role becomes making the patient aware of regressions to action modes, understanding the reasons for doing so, and subordinating this tendency to the verbal, symbolic mode. All mental functions work better and facilitate greater self‐regulation when they work in abstract, symbolic ways. Psychopathology can be understood as failing to develop or losing the symbolic level of organization, either in circumscribed areas or more ubiquitously. And mutative action occurs through helping our patients attain or regain the symbolic level in regard to all mental functions. Such work is best accomplished in the transference. The concept of transference of defense is expanded to all mental structure, so that transference is seen as the interpersonalization of mental structure. That is, patients transfer their mental structure, including their various levels of mentalizing, into the analytic interaction. The analyst observes all levels of the patient's mental functioning and intervenes to raise them to a symbolic one. At times, this will require action interpretations, allowing oneself to be pulled into an enactment with the patient that is then reprocessed at a verbal, symbolic level. Such actions are not corrective emotional experiences but are interpretations and confrontations of the patient's transferred mental organization at a level affectively and cognitively consistent with the level of communication. Nonetheless, the goal becomes raising the communication to a symbolic level as being able to refl ect symbolically on all aspects of one's mind with a minimum of restriction is the greatest guarantee of mental health.     

Role-Reversal: A Somewhat Neglected Mirror of Heritages of the Past

Within a clinical–theoretical framework focused on transference–countertransference dynamics, the authors reflect on role-reversal and on the reasons it has been neglected for a long time in literature. This primitive inter- and intra-psychic process, often at the forefront in our practice, will be discussed in its principal aspects (patient's unconscious identification with parents’ psychic culture and concomitant dissociation of the infant part of the self), signaling how the enactment can be an inevitable element which, putting into play the past dissociated object relationships, becomes a source of mutative understanding.     

REPORTING A DREAM ACCOMPANYING AN ENACTMENT IN THE TRANSFERENCE SITUATION

Patients with pathological organisations of the personality present the analyst with considerable technical difficulties. One of these problems arises from the fact that, in such patients, dreams frequently are not being used for communication of unconscious meaning, but instead for purposes of manipulation of the transference situation. They then represent attempts to identify the analyst with a part of the patient's self or with a particular internal object in order to draw him/her into collusive enactments. Following the work of Bion and Segal the paper presents a two-dimensional model in order to clarify the structure and use of dreams in this situation. The model may serve as a background orientation for the analyst in the clinical situation, as is subsequently illustrated in a detailed clinical sequence with a borderline patient. To conclude, the author suggests that whenever tendencies towards acting in are predominant, the interpretation of the enactment should generally be given preference over the interpretation of the dream content. The possible advantages and disadvantages of both strategies of interpretation are discussed. Finally, the author highlights consequences that arise when dealing with countertransference.     

Adult age differences in unconscious transference: Source confusion or identity blending?

Eyewitnesses are known often to falsely identify a familiar but innocent bystander when asked to pick out a perpetrator from a lineup. Such unconscious transference errors have been attributed to either identity confusions at encoding or source retrieval errors. Three experiments contrasted younger and older adults in their susceptibility to such misidentifications. Participants saw photographs of perpetrators, then a series of mug shots of innocent bystanders. A week later, they saw lineups containing bystanders (and others containing perpetrators in Experiment 3) and were asked whether any of the perpetrators were present. When younger faces were used as stimuli (Experiments 1 and 3), older adults showed higher rates of transference errors. When older faces were used as stimuli (Experiments 2 and 3), no such age effects in rates of unconscious transference were apparent. In addition, older adults in Experiment 3 showed an own-age bias effect for correct identification of targets. Unconscious transference errors were found to be due to both source retrieval errors and identity confusions, but age-related increases were found only in the latter.     

The therapeutic object relationship

This paper introduces the concept of the therapeutic object relationship in order to clarify our understanding of the nature of fully analytic work with the more regressive patient, which has unsystematically developed over the last 30 or 40 years. The need for such a clarifying concept seems to arise from several sources. Our analytic work with the more regressed patient appears to entail a relationship demand factor which cannot be usefully treated only as resistance to the development of the transference. These are patients with what may be described as object hunger emanating from faulted ego development and a disordered internal object world. This object hunger cannot be adequately met within the framework of the tacit, ordinary, good-enough environment of the concerned and nonjudgmental analyst. In addition, the literature on this subject still dichotomizes the relationship factor of treatment from the transference. The concept of the therapeutic object relationship appears to offer the possibility of a clinical and theoretical unification between transference and relationship. The major point of the paper may be described in terms of the manner in which we have progressed from Eissler's parameter paper of 1953 to the widened scope of analytic work made possible by object relations theory, developmental theory and observation of infant and child development. The face of analysis seems to have undergone profound modification from the early classical model to one in which developmental maturation, in addition to making unconscious conflict conscious, has become a matter for our concern. This change seems to require seeing the analyst as a special form of real object with whom the patient passes through a revised version of certain developmental pathways. The therapeutic object relationship is viewed as a potentially unifying concept which may make possible higher degrees of generalization about the variously unsystematized approaches to analyzing the more regressive, but nonpsychotic patient. Some history of definition of the analytic relationship in terms of transference or relationship is presented. In the course of the paper the therapeutic object relationship is gradually defined as one of: primal intimacy; increased permeability of boundaries between self and other; intensive empathic interaction; the evolution of self and object definition in a context of intimate relation with an object that is instrumental in this process; and the activation of transcendant forms of symbolic-creative intercommunication.(ABSTRACT TRUNCATED AT 400 WORDS)