The ego in diagnosis

This article highlights the salient issues in ego psychological assessment, and offers detailed suggestions on the conduct of such clinical procedures. The article emphasizes the importance of the anamnesis (or detailed, meaningful history), the patient's ego structure, the kind of trauma and its duration, the symptoms presented as well as the dynamic, genetic, and adaptive implications of the patient's symptoms and complaints. The determination of the ego's state is viewed as critical for adequate preparation for therapy and the evolution of the therapeutic relationship.     

The manifest dream in psychoanalysis: a clarification

Controversies about the value of the manifest dream in psychoanalysis are usually a matter of semantics. The author concludes that two clinically meaningful questions about the manifest dream can be asked: Is the patient's report of a dream useful in formulating an interpretation if no formal associations to the dream elements are given? Inasmuch as such reports always include some kind of associations, and the analyst always possesses considerable knowledge about the patient, the answer to this question would seem to be "Yes, at least at times." In what ways can the manifest dream contribute to our understanding of the dream and the dreamer? Both the literature and clinical experience indicate that there are many ways; these are summarized in an appendix. One approach, the direct decoding of manifest dream elements, is discussed in some detail. Several examples of the undisguised appearance of memories of childhood traumatic experiences in the manifest dream are presented.     

A significant "dream within a dream"

This brief clinical note is an attempt to clarify Freud's remarks regarding the significance of real occurrences of the "dream within a dream". There is affirmation of the reality of an actual event in the manifest dream (the "tickling" in adolescence). Certain representations regarding real events are alluded to in the manifest dream and are confirmed by the latent dream thoughts (the underlying homosexual theme involving the patient's mother and herself). Within the ongoing transference neurosis, a new understanding led this patient to experience intense sexual affects which were recalled for the first time during the course of an analytic session. The analyst's attention to this "dream within a dream" led to a facilitating active interpretation of the repressed sexual feelings. At the same time it was possible to observe a developmental arrest which had interfered with the consolidation of the patient's adolescent maturation begin to be undone by interpretation. The process of disengaging the patient from her unconscious bond with her mother (the undoing of the negative oedipal involvement) had been set in motion. The "dream within a dream" seems to represent a special defensive effort of the dream work to encapsulate the memory of one or more related actual events and the intense affects associated with them--affects whose pressure for discharge threaten to arouse the sleeper. The form the dream assumes is related to its hidden sexual origins and engages the active participation of both patient and analyst.     

The developing ego in group psychotherapy

Analytic group psychotherapy offers the potential for developing ego functions and enhancing identity formation. The nature of the interaction in group psychotherapy forces participants to deal with their perception of reality and revise their perceptions. After a brief review of the literature, focusing on the theoretical basis and ego development in analytic group psychotherapy, the paper discusses the following ego functions and gives an example of each: adaptation to reality, judgment, drive control, object relations (relationships with others), thought process and communication, defenses, affect differentiation, autonomy, mastery-competence, regulation of self-esteem, and frustration tolerance. The paper concludes with an example of assessing ego functions from a clinical vignette taken from one group psychotherapy session.     

A parapraxis in a dream

When a parapraxis is put on display in a dream, one can only wonder what service the willful mistake is rendering to resourceful dream work. Freud taught us that anything that appears in the manifest content of a dream may well be a disguise or a distortion of a subject that originally made an anxiety-provoking, and hence short-lived, first appearance in latent dream thoughts. Dreams in dreams and jokes in dreams have been examined from this perspective (Mahon 2002a, 2002b), and this paper focuses on the appearance and meaning of a parapraxis in a dream, with the argument that seemingly casual "mistakes" are highlighted in the manifest display to cover up some latent, much more deliberate subject matter.