Patients’ Pregnancies During Treatment: The Influence of the Analyst’s Psychology

Psychoanalytic therapists are today far more aware of countertransference effects, intersubjectivity, and mutual influence. The area that has been explored least in this two-person appreciation of psychoanalytic process is the effect of the psychodynamics of the therapist in a wide sense—that is, how the therapist brings a whole psychology, with a wide array of potential transferences, to each treatment. Triggered by the unexpected announcement of a patient’s expecting a baby, the author reviewed his practice and found that a large portion of his women patients ages 30–45 had become pregnant during therapy or psychoanalysis. The particulars were varied: how much the patient wanted a baby, whether the treatment was psychotherapy or psychoanalysis, the patients’ personality structure. Was the analyst’s psychology a common factor? The paper presents three quite different case examples and examines whether and how the author’s developmental and inner experience of women, sexuality, pregnancy could have contributed to a dyadic process that, in turn, could lead to pregnancy. If such effects happen, then it is important to look beyond and behind “anonymity” and “neutrality,” as well as momentary countertransferences, to the real-life effects that we have in our treatments.     

Veterans’ Offspring’s Personality Traits and the Intergenerational Transmission of Posttraumatic Stress Symptoms

Following war and war captivity, many combat veterans and former prisoners of war (ex-POWs) may suffer from posttraumatic psychopathologies, and these may be transmitted to their offspring. Though there are considerable individual differences between offspring in this respect, the mechanisms underlying such differences remain unclear. The current longitudinal study examined the role that veterans’ offspring’s Big Five personality traits may play within this intergenerational transmission. One hundred and twenty-three dyads consisting of veterans (79 ex-POWs and 44 combat veterans) and their adult offspring were examined. Fathers’ posttraumatic stress symptoms (PTSS) and global psychiatric distress (GD) were assessed 30 and 35 years after the war, and offspring’s PTSS, GD, and Big Five personality traits were assessed 40 years after the war. Findings indicate that veterans’ psychopathologies were associated with those of their offspring. Furthermore, analyses revealed significant positive associations between offspring’s psychopathologies and their Neuroticism, and negative associations with their Agreeableness and Conscientiousness. Finally, a mediation effect was found wherein the fathers’ PTSS and GD were related to their offspring’s Neuroticism levels, and the offspring’s Neuroticism was related to their PTSS and GD levels. These findings suggest that offspring’s personality traits may indeed play a role in the transmission of posttraumatic psychopathologies from veterans to their offspring, and may explain individual differences in this respect. Specifically, high levels of Neuroticism may place offspring at risk for secondary traumatization. Possible explanations and limitations are discussed, and future research directions are suggested.     

The Analyst’s Generous Involvement: Recognition and the “Tension of Tenderness”

I define the analyst’s generous involvement as inherent to human encounter and a necessary element of therapeutic process. When the analyst’s generous involvement goes missing, it can be read as a sign of disengagement and disconnection. Using as metaphor H. S. Sullivan’s concept of the “tension of tenderness,” I argue that the analyst’s recognition of a need or affect state in the patient evokes an internal tug constituting the analyst’s need to provide for what has been recognized. I elaborate on what the analyst’s generous involvement is, and what it is not, including countertransference pitfalls and corruptions that may masquerade as generosity. I engage a relational conversation with the radical ethical ideas of Emmanuel Levinas. An extended clinical vignette illustrates the challenges and conflicts entailed in the analyst’s finding an analytically useful form of expressing the tug of generous involvement in the immediate moment.     

The Tailor-Made Analysis: The Analyst’s Adaptation to the Patient and the Question of Time

The American Journal of Psychoanalysis - This paper considers Ferenczi’s views about the need for an adaptation of the analyst to the patient through a flexible management of time during some...     

Freud’s Legacy and Modern Theories of Ineffable Trauma

Notions of ineffability, what cannot be put into words, vary depending on the historical and cultural context and, in particular, on shifting linguistic ideologies about the capabilities and limits of language. In recent decades psychoanalysts have embraced a modern notion of ineffability centered around traumatic bodily experiences that are thought to be inexpressible. However, these ideas break with Freudian ideas about language and, most importantly, with his understanding of the processes of interpretation that give meaning to both psychic pain and attempts to heal it. Contra Freud, current theories of ineffable trauma re-inscribe a dominance of the body over the psyche and over-simplify Freud’s ideas about the retro-determination of trauma.

     

The Fee and the Analyst’s Life Cycle: Reply to Berger and Sopher

This response develops some further thoughts on the fee and its relationship to the analyst’s life cycle. Sigmund Freud’s letters to Karl Abraham from 1912 provide a window into how he thought about issues such as the fee, work–life balance and the place of writing and other efforts to give back to the profession. These same themes are fated to be re-discovered – as if for the first time – by each successive generation.     

The ad hominem argument of Berkeley’s Analyst

This paper responds to two issues in interpreting George Berkeley’s Analyst. First, it explains why the text contains no discussion of religious mysteries or points of faith, despite the claims of the text's subtitle; I argue that the subtitle must be understood, and its success assessed, in conjunction with material external to the text. Second, it’s unclear how naturally the arguments of the Analyst sit with Berkeley’s broader views. He criticizes the methodology of calculus and conceptually problematic entities, and the extent to which they require one to bend the rules of classical mathematics. Yet, elsewhere, Berkeley’s opinion of classical mathematics and its intelligibility is low, and he defends a pragmatic approach to word meaning that should not find fault with so functionally successful a theory. The ad hominem intention of the text makes it difficult to discern to what extent Berkeley is committed to the sincerity of these criticisms. This component of the text is rarely discussed, but I argue that when trying to decide what Berkeley’s true position is in the Analyst, we should treat its ad hominem component as its primary intention.     

Man on Wire: Walking the Therapeutically Transformative Tightrope of the Analyst’s Cancer

Almost nothing was clear to me when I was diagnosed with pancreatic cancer. I knew that I intended to inform all of my patients about my illness. But how could the focus remain on their needs when my mortality was so at risk? Unexpectedly, I discovered that I coped with my fears most effectively in my office. It was the one place where I could maintain a grasp on a holistic sense of myself and hold conflicting intense emotions. Additionally striking was the corresponding capacity of my patients to remain in treatment while addressing the unpredictable dyadic changes generated by my sickness. In this paper, I address this point of intersubjective transformation—the interactive contributions that generated each treatment’s unique rhythm. I also discuss the temporality of illness and how my continuing reconfigurations of self-experience impacted my ability to maintain authenticity and analytic balance both during and after treatment.     

Murakami's After the Quake—The Writer as Waking Dreamer and Trauma Analyst

In this paper I explore how Haruki Murakami depicts in profound and original images and nested stories the experience of traumatic dissociation and recovery. Murakami has an uncanny ability as a “waking dreamer” to capture and narratively elaborate core imagery. In his writings, he has examined the significance of imagination and dreaming in a person's bearing the complexity and multiplicity inherent in human existence. In “U.F.O. in Kushiro” the protagonist's reawakens from a numb, frozen state through a provocative encounter with someone who melts his frozen dissociation. There is a parallel to analytic working through of enactments stemming from trauma as described and elaborated by Bromberg.

Immersion in great imaginative literature can serve a restorative and generative purpose for the analyst-reader who so often has to wrestle with, and join, a patient's numbed, haunted adaptation to traumas, of the recent and distant past. Murakami's humor and evocativeness help me recover from the everyday depletion of clinical work on the edge of impasse. Literature and art help us regenerate and expand our capacity for complexity, imagination, and play in our daily practice and lives.     

A Group Analyst’s Perspective on the Trump–Clinton Election and Aftermath

Utilizing a group psychoanalytic perspective, the author examines group dynamics surrounding and generated from the Trump–Clinton election and the aftermath with particular attention to the emotional interactional relationship between the leader and the nation. Group dynamics are explored from a psychological, social, political, and historic context.     

Child’s Personality and Perception of Parental Relationship as Correlates of Optimal Experience

The study was designed to assess the influence of child’s personality and perception of parental relationship on children’s optimal experiences. We proposed functional and dysfunctional models to analyze the increase or the decrease of the children’s flow experience. The sample of this study included 909 middle class children, aged 9–12 (M = 11.02, SD = 1.08), both sexes, from Argentina. When we analysed the psychological factors that could be related to the flow state in childhood, we found out that the child’s perception of a functional parental relationship, in which there is either acceptance or moderate control, indirectly affects the flow experience, through child’s personality—extraversion, openness to experience, and conscientiousness. Functional personality traits have an important positive effect on optimal experience when they are considered as a unit. In the dysfunctional model of flow, the results showed that the child’s perception of parental pathological control had an important positive effect on neuroticism and –through this—a negative effect on flow. The child’s perception of parental negligence did not have a significant effect on neuroticism; however, neuroticism still maintained its negative effect on flow.     

Sex Differences in the Contribution of Respiratory Sinus Arrhythmia and Trauma to Children’s Psychopathology

Respiratory sinus arrhythmia (RSA), a marker of parasympathetic activity, has been shown to moderate the relation between adversity and child behavioral outcomes; however, this work has been conducted in primarily Caucasian samples and limited in focus to family-level adversity. The current analysis extends the previous literature to examine the co-contribution of exposure to potentially traumatic events (PTEs), baseline RSA, and RSA withdrawal to internalizing and externalizing behavior in a sample of primarily African American youth (n = 92) recruited using neighborhood mapping techniques from communities high in epidemiological indicators of adversity. Exposure to PTEs was associated with lower baseline RSA. Complex interactions were observed between sex of the child, baseline RSA and RSA withdrawal, and PTE exposure predicting to internalizing behaviors. Among girls with high (4+) levels of PTEs, high baseline RSA and RSA withdrawal predicted higher internalizing; for RSA withdrawal only, the inverse was observed for girls with low PTE exposure, for whom high RSA withdrawal predicted lower internalizing. No associations were observed from RSA to externalizing, or among boys to internalizing. Findings are consistent with distinct patterns among primarily African American samples and suggest the need for sex-specific conceptualizations of the link between environmental adversity, physiological reactivity, and internalizing behaviors.     

The Things We Carry: Finding/Creating the Object and the Analyst’s Self-Reflective Participation

I reflect on the interaction between the analyst’s dedicated attention to the patient’s internal object relations and the analyst’s self-reflective participation. Our stops and starts of attention to the patient’s internal objects and our own is in some sense one of the most important elements of our personal participation. I suggest that the patient’s and analyst’s needs for privacy and the illusion of privacy in the presence of the other, undertheorized within relational theory, is not at odds with an emphasis on valuing the patient’s capacity for a “read” on the analyst. Needs for privacy and the illusion of privacy held by patient and analyst need to be integrated into any psychoanalytic theory and form part of the basis of intimate regulatory systems between two people.     

Hitting the Bull’s Eye in Personality Disorders Psychotherapy

Psychotherapy of personality disorders (PD) is gaining momentum, though the progress has been mostly concerned borderline PD, with the other disorders largely neglected. In parallel, many empirically tested approaches focus on a limited understanding of psychopathology, for example poor mentalization or affect dysregulation, while PD are complex entities; they require clinicians paying attention to multiple therapy targets in order to be treated effectively and for a hope of actual recovery. I contend here that a more comprehensive account of psychopathology is needed; therefore the papers in this special issue focus on some of these aspects, such as difficulties in mental state understanding, dysfunctional representations of self with others, poor affect regulation and lack of access to adaptive and healthy self-aspects. The papers included in this special issue try and provide the readers with an intensive qualitative account of how therapists can act and yield improvements in these domains, with the hope of improving clinicians’ abilities to treat PD no matter what their preferred orientation is.     

A Review of “Trauma and Human Existence: Autobiographical,Psychoanalytic and Philosophical Reflections”

Abstract

The author sets out to locate Bion's model of the mind within the developmental history of psychoanalysis, from Freud to Klein to Bion, using biographical material and clinical case examples, to illustrate Bion's concepts of container/contained, his understanding and use of projective identification, his extension of the use of the countertransference, and his differentiation between the psychotic and non-psychotic aspects of the mind. Links, and attacks against linking are discussed, as well as Bion's thoughts about learning versus knowing, being versus becoming and his emphasis on the essential importance of the development of the capacity to think.     

Psychological Trauma,Christ’s Passion,and the African American Faith Tradition

This article argues that Christ’s passion/crucifixion functioned within the African American psyche as a religious narrative and symbol that uniquely addressed the severe trauma they underwent during the Middle Passage and slavery by enabling them to experience the presence of God in the depths of extreme suffering. Christ’s passion/crucifixion mirrored their experience of racial oppression and, thereby, provided a critique of the system and actors that perpetuated it. The Spiritual “Were You There?” is interpreted in this light. This correspondence between the African American’s historical experience and the narrative symbol of Christ’s passion/crucifixion helps explain their conversion to Christianity.     

Benjamin’s Children’s Theater and the Problem of Pure Means

Studies in Philosophy and Education -     

Erikson’s Schedule of Human Strengths and the Church’s Self-Images

This article focuses on Erik H. Erikson’s schedule of human strengths presented in his essay, “Human Strength and the Cycle of Generations” (Erikson 1964) and suggests that certain images of the church support these human strengths. In supporting these human strengths, they also contribute to our understanding of the importance of the fact that the church is an intergenerational body.     

Anorexia Nervosa and the Analyst’s Paternal Function: Response to Schoen,Zerbe, and Boulware

To expand upon the commentaries by Schoen, Zerbe, and Boulware (this issue), I clarify my thinking about the entropic body as a defensive structure. I then introduce my own theorizing about the relationship between agency and anorexia nervosa. In agreement with Schoen that these patients relegate their agency to the somatic realm, I highlight the aggressivity of that agency. Amplifying Zerbe’s recognition of the patient’s “father hunger,” I point out the importance of the paternal presence in helping these patients to modulate their aggression and, in the process, develop their agency.     

Even More Than the “Something More”: Tronick’s Dyadic Expansion of Consciousness Model and the Expansion of Child Psychoanalytic Technique

Contemporary psychoanalysis considers itself to be a discipline fundamentally concerned with meaning and meaning-making processes. Ed Tronick’s research provides scientific support for the theoretical position that meaning making is a central process in psychological development and in mental health/illness. His work collaborating with psychoanalysts has made major contributions to the psychoanalytic literature on therapeutic action, with a special emphasis on the means by which implicit meanings are activated and modified in analytic treatment—the something more than interpretation. This article is about a different something more, the even more that psychoanalytic theory and technique can evolve through further incorporating Tronick’s important findings. Tronick’s Dyadic Expansion of Consciousness Model will be briefly reviewed—emphasizing his conceptualization of meanings as being composed of multiple commingling layers (biological, psychological, relational, and social) coming together in a nonlinear “messy” mixture of mutually influencing (both bottom-up and top-down) currents. This multilayered model of meaning opens up the reconsideration of an exciting array of technical options—traditionally considered nonanalytic—to be reunderstood as truly psychoanalytic in that they address one or more of the implicit or explicit levels of meaning that a patient makes of his or her self and world. Examples of these interventions include parent work, work with teachers and schools, as well as interventions adapted from other disciplines such as Occupational Therapy. These technical possibilities are illustrated using case material from the psychoanalytic treatment of a nine-year-old boy.