Freud’s Three Theories of Neurosis: Towards a Contemporary Theory of Trauma and Defense

This paper explores the development of Freud’s thinking on the aetiology of the neurosis. It is shown that Freud in the years 1893 to 1897 formulated three distinct and mutually incompatible theories of neurosis centred respectively on (a) psychic trauma and defence, (b) sexual trauma (seduction), and (c) repressed sexuality (libido). For Freud the decisive step was the shift from the first to the second theory, not from the second to the third. It is examined how Freud gave priority to the libido/fantasy theory until he returned in 1926 to a general trauma theory with his second theory of anxiety. The fate of Freud’s theory of neurosis in later psychoanalytic thinking is described as a process of dilution rather than an exploration of what is right and what is wrong in the theory. It is argued that the basic fault common to Freud’s second and third theories is the insistence on an exclusive sexual aetiology of the neurosis. On the other hand, it is argued that Freud’s first theory, centred on emotional trauma and defence, has turned out to be basically right and is therefore well suited to constitute a basis for a contemporary theory of neurosis (non-neurological mental disorders).     

The centrality of the psychoanalytic setting and the changing aims of treatment. A perspective from a theory of object relations

The psychoanalytic setting, which includes the bond between analysand and analyst, is the foundation of psychoanalytic treatment. This object tie, although in the here and now, and "real", is demarcated from ordinary life and can be thought of as existing within a different level of reality. The psychoanalytic setting is subject to symbolic transformations that enable non-specific developmental conflicts to be worked through. I have described this transformation as the "dependent/containing transference," which I have compared and contrasted to the highly variegated and specific "iconic" transference (transference neurosis). This view of the psychoanalytic setting leads the analyst to pay special attention to problems of entrustment and safety and to the communicative process that regulates the closeness and distance between the two participants.     

The transference neurosis in Freud's writings

This paper reviews the evolution of the concept of transference neurosis in Freud's writings. It suggests that the language in which the concept of the transference neurosis is originally expressed by Freud includes an idea of the analyst as aggressively pursuing the analytic cure by waging a solitary battle against the patient's disease. With the representation of the death drive and the larger role accorded to sadism as its external manifestation in Freud's revised drive theory of 1920, the patient becomes the ally; resistance, in the sense of the conservative forces, not disease, in the sense of libidinal conflict, becomes the enemy. It is thus difficult to speak of a transference neurosis in the circumscribed way Freud originally meant it, and he ceased to use the term after 1926 rather than redefine it to fit his broader perspective. In this broader perspective, relative resolution of conflict replaced radical liberation of the patient from disease. That Freud did not redefine the term does not imply that he discarded it, or that we necessarily should. This paper suggests that Freud implied a functional distinction between transference as transforming agent and transference neurosis as result of that transformation. That distinction defines psychoanalytic cure in terms of the understanding of a symbolic transformation which is, through the transference neurosis, reexperienced as part of the psychoanalytic process.     

The use of dreams in the clinical context: convergencies and divergencies: an interdisciplinary proposal

This paper aims to define some unexpected convergences and foreseeable divergences regarding the conceptualization of dreams and their use as a research tool, specifically in clinical practice with non-neurotic patients. It includes a concise review of different lines of thought on the vicissitudes of dreams throughout the history of psychoanalysis: from their initial conception up to their use to examine transference and relational aspects in the context of a psychoanalytic process. The idea of the merely evacuative function of dreams from patients in certain diagnostic categories is discussed and compared with that of their potential communicative value. Lastly, the essay sets forth an interdisciplinary semiotic-pragmatic approach to the function of dreams and their clinical and technical use in the context of the intersubjective dynamic field. Based on the hypothesis that dreams related in the session are communicative signs, this proposal argues their significance as a symbolic matrix that generates processes of psychic semiosis. To do so, it combines certain lines of psychoanalytic thought with ideas coming from C. S. Peirce's analytic semiotics. Clinical material is included to illustrate this viewpoint.     

Childhood and Trauma

In this paper, I follow the evolution of the concept of trauma within psychoanalytic theory, and some of the effects of this evolution. Starting out from the point where Freud gives up the theory of trauma as the cause of neurosis in 1897, and the alleged reasons for such a change, I analyze the theoretical and clinical consequences of this change within psychoanalysis. I proceed to develop Ferenczi's ideas on trauma, their relevance to present-day psychoanalytic theorizing and practice, as well as for the understanding of the psychic processes in children, tracing the development of some of these ideas in contemporary psychoanalytic thinking.     

Slow magic: psychoanalysis and "the disenchantment of the world"

Freud's work can be situated in terms of the debate between Enlightenment and anti-Enlightenment thought. The attempts of both sides to claim Freud for their position have merit, but they miss the crucial point: namely, that the tension between its Enlightenment and anti-Enlightenment tendencies is what gives Freud's thinking much of its vitality and depth. The task that faces the interpreter is therefore to elucidate that tension and assess the alignment of forces between the two strands in his thought. An examination of the concept of magic in Freud's theory provides an opportunity to pursue this interpretive task. Although the Enlightenment position he often seems to embrace advocates the complete elimination of magic, many "magical" elements remain in his theory and clinical practice. Nor should this situation be deplored, for the ambition to completely exorcise "enchantment" from human experience is one of the misguided excesses of the Enlightenment. The question of an appropriate fate for magic in psychoanalysis is discussed in relation to the vicissitudes of the transference. Finally, the science versus hermenueutics debate is examined in the light of these considerations in an attempt to specify the unique nature of the psychoanalytic experience.     

Castration

Castration is not a metaphor within the array of psychoanalytic theories, but a pathological belief operative in the unconscious, which originated during the period of childhood sexuality. Of the two major anxieties, separation and castration, castration anxiety is the most overlooked in clinical discourse and theoretical awareness. Castration conflicts have a developmental history and are composed of phases as much as separation-individuation is. These extend from the preoedipal to the oedipal years and beyond and, as separation conflicts, persist throughout life. Clinical material is demonstrated from across the diagnostic spectrum and all developmental levels. Phylogenetic studies are corroborative. As loss of love is a wider derivative of separation anxiety, castration anxiety radiates out to wider fears of invasion and injury to the body. The transference neurosis is more attuned to encompass separation than castration conflicts. This stratum of psychopathology makes reconstruction and the recovery of historical data indispensable.     

Re-reading "Little Hans": Freud's case study and the question of competing paradigms in psychoanalysis

Psychoanalysts have long recognized the complex interaction between clinical data and formal psychoanalytic theories. While clinical data are often used to provide "evidence" for psychoanalytic paradigms, the theoretical model used by the analyst also structures what can and cannot be seen in the data. This delicate interaction between theory and clinical data can be seen in the history of interpretations of Freud's "Analysis of a Phobia in a Five-Year-Old Boy" ("Little Hans"). Freud's himself revised his reading of the case in 1926, after which a number of psychoanalysts--including Melanie Klein, Jacques Lacan, and John Bowlby--reinterpreted the case in the light of their particular models of the mind. These analysts each found "evidence" for their theoretical model within this classic case study, and in doing so they illuminated aspects of the case that had previously been obscured, while also revealing a great deal about the shifting preoccupations of psychoanalysis as a field.     

The role of support in psychoanalysis.

A two-factor theory of clinical psychoanalysis is proposed. In accordance with the predominant position of the structural-adaptational ("classical") approach in psychoanalytic theory, the power of interpretation and insight in clinical psychoanalysis has received ample attention in psychoanalytic literature. There seems, however, to be a growing awareness among analysts that not all the facts of an analytic treatment can be accounted for by this approach alone. A second factor is increasingly recognized: the power of adequate support provided by the analyst and resulting in a specific experience by the analysand. In the application of the developmental ("postclassical") approach of psychoanalytic theory, the importance of this support-experience factor in the treatment of ordinary neurosis by means of ordinary psychoanalysis is emphasized. The relative neglect of this aspect of clinical psychoanalysis may be indicative of the present-day dilemma of how to translate advances in theoretical knowledge of mental development into the therapeutic praxis of psychoanalysis. There may, however, be another important reason. Support and experience are phenomena often occurring on the nonverbal level. In contrast to interpretation and insight, they are usually not voiced, let alone distinctly and loudly expressed. They are the silent power of psychoanalysis.     

False Memories,Negative Affects,and Psychic Reality: The Role of Extra‐Clinical Data in Psychoanalysis1

Psychoanalysis as a treatment originated in the idea that neurosis is related to the ways in which individual psychic reality departs from actuality. Psychic reality includes memories, beliefs and their associated affects and fantasies connected with an individual's experience of the inner and outer world. The psychoanalytic determination of what meaningful memories or beliefs are inaccurate, distorted or false ordinarily relies upon principles of intra‐clinical validation. By itself, however, intra‐clinical validation is subject to limitations and pitfalls that conviction alone about what is actual cannot circumvent. Despite this fact, there are remarkably few analytic case reports demonstrating false or signifi cantly distorted memories through the use of data obtained from outside the consulting room. This paucity of reports may be related, at least in part, to the belief that the use of extra‐clinical data is essentially unanalytic or supports resistance. Based on the views that (a) psychic reality cannot be regarded as exclusively subjective or objective but is inherently both; and that (b) a goal of analysis is to achieve a different, acceptable and more accurate view of reality, the authors report a clinical case involving a confi rmably false pivotal memory and its associated negative affects. They discuss theoretical and technical considerations in utilizing extra‐clinical data during the treatment process.     

Max Eitingon and a Question of Politics

Max Eitingon is thought not to have left behind original theoretical work, despite the fact that he wrote some 40 articles and a dozen psychoanalytic congress reports. He has been almost forgotten over the years, even though he occupied an important political place in the history of the psychoanalytic movement. In recent times, he has again become a subject of attention. In this article the author takes a look at Eitingon as an activist who was intensely involved in the social and political struggles of his time. He represents the political aspect of psychoanalysis on two counts: first, within the psychoanalytic movement, where he had a particular role in the institutionalizing of psychoanalysis, and, second, in relating it to wider social and political ends.     

A psychoanalytic view of the Rorschach Comprehensive System "special scores"

We analyzed the contemporary empirical and theoretical literature concerning the two predominant approaches for scoring formal thought disorder on the Rorschach, the Comprehensive System special scores, and the methodology of Rapaport, Gill, and Schafer (1946/1968). The psychoanalytic research related to selected special scores is reviewed, and some linkages to psychoanalytic developmental theory and psychopathology are made. Recommendations are presented to bridge the gap between these two important avenues of Rorschach research, with an emphasis on empirical rigor and intrapsychic contextual meaning.     

An Independent Theory of Clinical Technique

The history of Independent analysis in the British Psychoanalytical Society is reviewed. The Independent Tradition, as an approach to psychoanalysis, is distinguished from the organisational grouping in the British Society that is the Independent Group. The Independent Tradition emphasises what differentiates human beings rather than how they exemplify general principles. This derives from Freud through Ferenczi. Ferenczi's stress on the quality of the patient's experience, on the need for analysts to be aware of the effect on themselves of the analytic process, and on the need for restraint in interpretation are all characteristically Independent aspects of analytic technique. Later Independent thinkers have developed these themes further. Especially important is Enid Balint's idea that theory mediates the analyst's creative imagination. The analytic setting infuses ordinary human interaction with psychoanalytic awareness, and another function of theory is to imbue with psychoanalytic understanding the use of everyday language. Independent clinical technique is primarily a way of listening. Regression is accepted, and free association valued as being in itself a vehicle of psychic growth. A central idea is that the analyst is an analytic object to be made use of by the patient. Several clinical examples illustrate the functioning in practice of these concepts.     

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.     

Identifying marks of Latin American psychoanalysis Towards the defi nition of a River Plate model1

The author considers the infl uences that different psychoanalytic trends have had on the thought processes of psychoanalysts in the River Plate region. She begins by giving a history of the way in which these trends were shaped by the sociocultural context of the region, and of how the dialectical relationship between these two factors produced the River Plate region's (Argentina and Uruguay) own theoretical model. The author includes a study‐albeit incomplete‐of major local developments, and attempts to defi ne the characteristics of a regional model. The model is based on the following parameters: the fundamental rules of evenly suspended attention and free association; the technical frame; links between theory and clinical practice such as transference‐countertransference, resistance, identifi cation, the analytic fi eld; the concept of psychic change and its indicators; and the interpretive instrument. The author considers the past and present infl uence of Lacanian thought on this model. She concludes by reviewing some of these theoretical and clinical concepts.     

Psychoanalytic treatment of a woman with anxiety attacks and conversion

This case study describes the psychoanalytic treatment of a young woman presenting with symptoms of overwhelming anxiety, panic, and conversion. The emphasis is on technique with detailed reporting on the psychoanalytic process. Attention is paid to transference-countertransference paradigms at critical junctures in the treatment. The role of clinical supervision in the unfolding of the process is described also. This patient developed an identifiable transference neurosis during the course of the treatment, which became the focus of the analysis. Follow-up observations on this patient are also presented, as she returned for a brief course of treatment 4 years following initial termination.     

Some observations on the psychoanalytic process

The author's aim is to delineate the psychoanalytic process and to distinguish it from the psychoanalytic situation, the transference neurosis, "insight," and psychoanalytic technique in general. Freud's 1913 views provide the basis for a concept of the psychoanalytic process centered on the recognition and interpretation of resistances and on the patient's reactions to the analyst's interventions. This clinically observable "unit" of the process is described and compared with Bernfeld's "facts of observation." The proposition is advanced that the process does not come to an end with the termination of analysis. It continues postanalytically in the form of the patient's more objective and more effective capacity for self-observation. The paper closes with a warning about the "pitfalls of perfectibilism" and with a plea for the elevation of the not-so-good analytic hour.     

Ferenczi and Winnicott: Searching for a “Missing Link” (of the Soul)

The aim of this paper is to present the close link between Ferenczi's and Winnicott's theoretical, clinical and therapeutic thought, indicating how this link has become something of a “missing link” in the history of psychoanalytic ideas, an implication which we retain, in part, to this day. In the first part entitled “Who's speaking to whom?”, I aim to explore the contents of the most essential parts of their messages, stressing the similarities and differences between them, and citing the most important authors whom they address (Freud for Ferenczi, Klein for Winnicott). In the second part, I aim to tackle the general direction underlying both their work and their lives, concentrating specifically on “the maternal”, and examining the repercussions of this aspect on psychoanalytic technique and practice. In the third part, as a kind of “Parting”, I will present further brief conclusions on the relevance and significance of their thoughts in modern day psychoanalysis, defining Ferenczi and Winnicott as “founders of future discursiveness”.     

The so-called rule of abstinence revisited

The paper discusses whether the rule of abstinence is still valid in the contemporary theoretical arena of psychoanalysis. Not only is this a debate on principle. It also raises the question of how gratifying the analyst should be in the analytic encounter, still remaining within the psychoanalytic paradigm. Current criticisms of the concept of abstinence are reviewed. The author replies to the objections. He argues that the so-called rule of abstinence is not a “rule” which describes the particular behaviour of the analyst, but a general principle describing the essence of the psychoanalytic cure. In the opinion of the author, abandoning this principle may have detrimental consequences both theoretically and technically. Finally, the author discusses the emotional presence of the analyst in the analytic setting and suggests an updated version of the idea of analytic abstinence.