On psychic elements in a case of autistoid perversion

The paper explores the formation of psychic elements from an epistemological point of view, drawing on the work of Bion to examine a clinical case of autistoid perversion. Distinguishing the qualification of psychic elements from the realization of pre‐conceptions, the paper argues that psychical elements are constituted through a mutually shared experience of presence, and so they should be understood in a paradoxical way – through being‐O and transformations into K. These ideas are explored via a clinical case concerning a patient with an autistoid–perverse organization. The patient had been denied any bodily contact with her parents during her first year of life due to an infection; in later life she exhibited an autistoid coprophilic perversion. During the course of her treatment, as it became possible to break down the autistoid organization, the nameless contents surfaced in a mutually shared experience of presence. The analyst was able to hold on to their meaning, which was unavailable to the patient. The absent analyst, however, turned into the mother who ‘put the child down’ and was experienced by the patient as a suicidal threat. In being‐O, the analyst was able to endure the paradox of being the one who ‘put her down’ in order not to put her down; the paradox of being‐O functioned as a container for the destructive objectal dimension of the state of ‘being put down’.     

The perversion of language in the analyst's activity: Navigating the rhythms of embodiment and symbolization

Abstract

In this short text, the problem of how “the talking cure” itself can become a perverse relation is considered and illustrated with a brief clinical vignette. Contributions coming from the work of Stern in infant research and Lacan in post-Freudian thought illuminate the potential for experience to be split off through the use of language itself. These perspectives are brought to bear on thinking about representation, splitting, and perversion as a basis for considering a clinical instance in which patient and analyst enact a perverse relation constituted by the way in which the patient uses the analyst's language to construct a sado-masochistic perversion of the treatment process. Within the clinical episode, Stein's reformulation of perversion, informed by Ogden's observations and expanding Stoller's earlier contribution, provides a basis for considering how the analyst was able to use attention to the body-based countertransferential experience to repair a sense of “erasure” that was being accomplished for both analyst and analysand through the enactment.     

A psychoanalytical phenomenology of perversion1

After stating that the current tasks of psychoanalytic research should fundamentally include the exploration of the analyst's mental processes in sessions with the patient, the author describes the analytical relation as one having an intersubjective nature. Seen from the outside, the analytical relation evidences two poles: a symmetric structural pole where both analyst and patient share a single world and a single approach to reality, and a functional asymmetric pole that defines the assignment of the respective roles. In the analysis of a perverse patient, the symmetry‐asymmetry polarities acquire some very particular characteristics. Seen from the perspective of the analyst's subjectivity, perversion appears in the analyst's mind as a surreptitious and unexpected transgression of the basic agreement that facilitates and structures intersubjective encounters. It may go as far as altering the Aristotelian rules of logic. When coming into contact with the psychic reality of a perverse patient, what happens in the analyst's mind is that a world takes shape. This world is misleadingly coloured by an erotisation that sooner or later will acquire some characteristics of violence. The perverse nucleus, as a false reality, remains dangling in mid‐air as an experience that is inaccessible to the analyst's empathy. The only way the analyst can reach it is from the ‘periphery’ of the patient's psychic reality, by trying in an indirect way to lead him back to his intersubjective roots. At this point, the author's intention is to explain this intersubjective phenomenon in terms of metapsychological and empirical research‐based theories. Finally, some ideas on the psychogenesis of perversion are set forth.     

The analyst's excitement in the analysis of perversion

The author believes that unconscious sexual excitement in the transference and countertransference is an especially problematic aspect of the analysis of perverse character pathology and that perverse sexual gratifi cation deserves a more prominent position in the clinical theory of analyzing perversion than that which has been assigned tacitly through analysts' routine focus on the defensive and destructive dynamics of perversion. He presents clinical material from the analysis of a perverse patient that illustrates the role of excitement in the transference perversion established in this analysis; and he asserts that gratifying perverse enactments occurring in the transference perversion can appear not only as conscious or unconscious excitement in the transference but also, at times most clearly, as the analyst's excitement. The author suggests that using a clinical theory that supports the analyst in understanding his excited responses as perverse countertransferences-i.e. evoked excitement complementary to the sexual component of a perverse transference-will assist him in locating and thinking about gratifying, perverse excitement in the transference where it is most usefully analyzed. Finally, he discusses some of the reasons why analysts might deny, suppress or otherwise avoid perverse countertransferences and in so doing contribute to sustaining perverse resistances.     

A fresh look at perversion

The history of ideas about perversion is considered, along with an examination of whether the concept is clinically useful. Three cases of varying degrees of severity are presented, illustrating the clinical value of the concept in the analytic situation. All three cases are women, and the particular usefulness of the concept of perversion for women is noted. The place of aggression and the pleasure resulting from its expression are highlighted.     

A metasynthesis of published case studies through Lacan's L‐schema: Transference in perversion

Transference in perversion is characterized by specific problems such as a defiant and polemic attitude, erotic transference, projections, and aggression. Such transference poses particular problems in the treatment of perversion and might render analytical work with these patients impossible. The authors propose that Lacan's L‐schema can contribute to separating productive from counterproductive aspects of transference as it distinguishes between an Imaginary and a Symbolic dimension in transference. In this meta‐synthesis of 11 published case studies on sexual perversion, patterns of transference are analysed. On the Imaginary dimension, the authors found that patients with perversion tend to (un)consciously engage the analyst in a relationship characterized by identification, fusion and rivalry. On the Symbolic dimension, they found that perverse patients are able to question their motives, lapses, symptoms, and subjective identity. The thematic analysis revealed the importance of the position of the analyst in this work, which is described within the L‐schema as being the representative of the otherness in the Other. Implications for clinical practice and recommendations for further research are outlined.     

Psychoanalytic perspectives on paraphilias and perversions

Since Freud’s exposition of the nature of perversion in his seminal work, Three Essays on the Theory of Sexuality there has been a multitude of rich and varied explorations of human sexual fantasies and behaviours that are considered as perversions within the psychoanalytic literature. However, with more recent societal shifts towards the acceptance of sexual orientations and practices which would previously been categorized as deviant, perversion has become a pejorative term seen as stigmatizing and debasing those whose sexual preferences do not conform to the traditional norm. In this paper I argue that certain psychoanalytic concepts of perversion retain utility in how we might think about and help individuals whose sexual desires and practices cause distress to themselves and/or others, particularly in the realm of intimate relationships. Historical and contemporary theories about the nature and origins of perverse fantasies and behaviour are presented and explored, focusing on how perversion may be conceptualized as a defence against early anxieties and disturbances in the mother–infant relationship. Such ideas inform a psychoanalytic approach to the treatment of perversions, particularly in consideration of transference and countertransference dynamics. The ideas in this paper are based on my work at the Portman Clinic in London, UK.     

Perverse relationships: The perspective of the perpetrator

The author examines the theme of perverse relationships within the couple, focusing on the question of men's maltreatment of their female partners, particularly in the psychological sense. Various aspects of the perpetrator's personality and relational style are described. The author takes as her starting point and discusses in depth the concepts of narcissistic perversion (Racamier, 1992) and relational perversion (Pandol, 1999), considered useful for understanding and identifying this type of pathology. She postulates that maltreating behaviour, in fact, originates from the encounter of particularly non–empathic relational styles which are typical of certain personalities (mainly, but not exclusively, of the narcissistic disorder) with perversity, that is, perversion, understood as a character trait. The author makes a distinction between relational perversion and sado–masochistic relationship, and presents a clinical picture deriving from the analysis of a man who maltreats his companion, in order to shed light on the above–mentioned aspects, touching on some problems arising in the analysis of such patients. In conclusion, she considers some aspects of the experience of victims of maltreatment.     

The analyst in action: An individual account of what Jungians do and why they do it1

This paper describes some similarities and differences between contemporary approaches to analysis as practised by ‘Freudians’ and ‘Jungians’ in London today. It aims to contribute to mutual understanding between different schools of analysis by showing how the analyst’s interventions can only be understood in terms of the theoretical context from which they arise (cf. ‘the analyst’s preconscious’, as discussed by Hamilton [1996] ). A discussion of five key themes of Jungian theory is followed by an account of clinical work with a patient who enacted her inner world through the use of material objects brought to the consulting room, presenting difficult technical dilemmas concerning boundaries and enactment. The paper aims to shows how these Jungian themes influenced the analyst’s response, particularly in relation to ideas of symbolic transformation, the unknowable nature of unconscious processes and the purposive orientation of the self towards wholeness and integration.     

Pentheus rather than Oedipus: On perversion,survival and analytic ‘presencing’1

Following an introductory review of the main developments in the psychoanalytic thinking on perversion, the author focuses on her own understanding of perversion and its treatment, based on the psychoanalytic treatment of patients with severe sexual perversions. This paper uses the term ‘autotomy’ (borrowed from the fi eld of biology) to describe perversion formation as an ‘autotomous’ defence solution involving massive dissociative splitting in the service of psychic survival within a violent, traumatic early childhood situation; thus, a compulsively enacted ‘desire for ritualised trauma’ ensues. The specifi c nature of the perverse scenario embodies the specifi c experiential core quality of the traumatic situation. It is an actual repetition in the present of the imprint of a past destructive experience which is pre‐arranged and stage‐managed; it thus encounters haunting scenes of dread or psychic annihilation while, at the same time, controlling, sanitising and disavowing them. Hence, the world of severe perversion is no longer oedipal, but rather the world of Pentheus, Euripides's most tragic hero‐a world dominated by a mixture of a mother's madness, devourment, destruction and rituals of desire. According to this view, the (diffi cult) psychoanalytic treatment of perversion focuses on patient‐analyst interconnectedness‐brought about by the analyst's ‘givenness to being present’ or ‘presencing’‐at a deep, primary level of contact and impact (the emphasis being on the ontological dimension of experience). This evolving therapeutic entity creates and actualises a new, alternative experiential‐emotional reality within the pervert's alienated world, eventually generating a change in the perverse essence. The author illustrate this approach with three clinical vignettes.     

THE EFFECT OF THE ANALYST'S GENDER AND OTHER FACTORS ONPOST-TERMNATION PATIENT-ANALYST CONTACT: CONFIRMATIONBY A QUESTIONNAIRE STUDY

This questionnaire study was designed to confirm and further explore an earlier finding of a gender difference in post-termination patient-analyst contact, as well as to assess whether practices regarding post-termination contact have changed in the five-year interval since the first study. The hypothesis that women analysts are more likely to have post-termination contact with their analysands than men analysts was confirmed by the present study. Analysts who report thinking frequently about their most significant analyst are contacted by a much larger proportion of prior patients than those who rarely think about their analyst. Further, women analysts are more likely to feel they benefited from the analysis they consider their most significant analysis, and to feel positively about that analyst. In 1994, analysts were much more accepting of and more likely to propose post-termination contact than in 1989. What the analyst reports he/she says to the patient is associated with the likelihood of such contact.     

Befores and Afters of the Womb: Reply to Commentaries by Jeanne Wolff Bernstein and Dodi Goldman

This reply engages with Wolff Bernstein's and Goldman's rich discussions of Farhi's work. Wolff Bernstein's exploration of the relationship between Winnicott and Susan as a perversion of the phylogenetic shield operative in primal repression furthers our understanding of Milner's treatment of her patient. Following Wolff Bernstein's thoughts of the problems caused by Winnicott's mishandlings of Susan, I suggest that we might consider the referral process itself as an analogue to pre-natal life, the conscious and unconscious significations of which can have an important impact on the qualities of relational bonds to be built with the treating analyst.

Goldman's commentary deepens our insight into Milner as a person and as an analyst. At the same time, it also raises an important question about how early in biological life it is logical to assume the possibility of psychic material's registration, which Goldman sees as equivalent to considerations of psychic organization. Seeing the two as temporally distinct, I draw from critical analyses of Laplanche's theory to discuss how experience can be registered as yet-misaligned bits that await a later developmental time before it can become invested with meaning and become psychically organized.     

Becoming (and Remaining) an Analyst in Latin America

The following overview of the development of psychoanalysis in Brazil and in Porto Alegre outlines the current situation and the challenges to psychoanalysis in my country. I will explain my own experiences on becoming an analyst, the main reasons for my choice, my main influences, and my evolution as a clinical psychoanalyst and as a member of psychoanalytic and psychiatric institutions. I include my main contributions to psychoanalysis and consider two broad areas of interest: psychoanalytic technique and its teaching, and the relationship of psychoanalysis and culture. As for the former, my main interests are studies on countertransference and analytic neutrality, to which I will propose a comprehensive concept. As for the latter, I discuss a culture that contrasts vividly with the one in which Freud created the discipline, psychoanalytic views on violence and perversity, psychoanalytic institutions, and the application of analytic ideas for the understanding of some artists and their work.

I will also describe some general features of my country and the development of psychoanalysis in it; report my experiences as a candidate and an analyst; and offer some information about my evolution as an analyst through papers I have written over the past 30 years.     

Fromm's Impact on Interpersonal Psychoanalysis: A Well Kept Secret

Erich Fromm was one of the founders of the William Alanson White Institute in New York City and an important contributor to the development of the interpersonal approach to psychoanalysis. Many of Fromm's ideas about psychoanalysis have found their way into the mainstream of analytic thinking. Much of what he taught in supervision and in his lectures had to do with the role of the analyst, the analyst's use of himself in the analytic process and the necessity that the analyst experience what his patient is experiencing. From did not necessarily use terms like projective identification but his understanding presaged much of what analysts talk about today. Fromm himself did not write much about clinical practice. And while he repeatedly expressed his respect for Freud he was explicit in his disagreements. Fromm rejected the notion of the analyst as a blank mirror. Instead, analysis requires a passionate wish for truth both in the analysand and the analyst. Fromm calls this passion biophilic, implying that the unconscious does not only harbor destructive drives that need to be tamed; it also harbors creative drives which, while also irrational, are constructive and need be liberated through the analysis.     

The disregarded analyst and the transgressive process: discontinuity, countertransference, and the framing of the negative.

This paper describes the difficulty of working with patients who have adopted conflict solutions common to perversion. These analysands' rapid shifts from one discontinuous mental state to another draw the analyst into a regressive transference/countertransference engagement characterized by alternations of actualized self and object representations. The analyst's disengagement from this regressive interaction is crucial, but difficult. A detailed clinical example illustrates the process of disengagement as well as the transformation of this transference into a more traditionally consolidated one. A technical approach is suggested and questions of representation and symbolization are explored.     

Residues in the analyst of the patient's symbiotic connection at a somatic level: unrepresented states in the patient and analyst

This paper discusses the residues of a somatic countertransference that revealed its meaning several years after apparently successful analytic work had ended. Psychoanalytic and Jungian analytic ideas on primitive communication, dissociation and enactment are explored in the working through of a shared respiratory symptom between patient and analyst. Growth in the analyst was necessary so that the patient's communication at a somatic level could be understood. Bleger's concept that both the patient's and analyst's body are part of the setting was central in the working through.     

Ordinary Sadism in the Consulting Room

The analyst’s retaliatory sadism can be construed as a perversion of the wish to penetrate, just as masochism can be viewed as a degradation of the desire to surrender. When a patient refuses to speak any other language but that of domination and submission, ordinary attempts for communication and recognition fail. In her attempt to reach the patient, to reinstate herself as an active agent and subject, and also to dislodge the patient from a rut of despair, passivity, or malignity, the analyst may escalate to a sadistic response, even if she suspects that this might cause the patient pain. This type of sadomasochistic enactment can gather strength when disowned self-states of analyst and analysand are activated. In this process, an analytic interpretation, seemingly legitimate, can be used as a knife, a weapon, an instrument of retaliation and sadistic control. The disastrous potential of the analyst’s sadism is easy to imagine. Through a couple of clinical vignettes I will demonstrate that even something as lamentable as the analyst’s sadistic retaliation can lead to growth as long as such sadism can enter the analytic dialogue and the patient is allowed to perceive and reflect upon the analytic misbehavior, and the analyst is willing to join the patient in the quest to understand their co-created predicament.     

Associative dreaming: reverie and active imagination

The idea of countertransference has expanded beyond its original meaning of a neurotic reaction to include all reactions of the therapist: affective, bodily, and imaginal. Additionally, Jung's fundamental insight in 'The psychology of the transference' was that a 'third thing' is created in the analysis, but he failed to demonstrate how this third is experienced and utilized in analysis. This 'analytic third', as Ogden names it, is co-created by analyst and analysand in depth work and becomes the object of analysis. Reverie, as developed by Bion and clinically utilized by Ogden, provides a means of access to the unconscious nature of this third. Reverie will be placed on a continuum of contents of mind, ranging from indirect to direct associative forms described as associative dreaming. Active imagination, as developed by Jung, provides the paradigm for a mode of interaction with these contents within the analytic encounter itself. Whether the analyst speaks from or about these contents depends on the capacity of the patient to dream. Classical amplification can be understood as an instance of speaking about inner contents. As the ego of the analyst, the conscious component, relates to unconscious contents emerging from the analytic third, micro-activations of the transcendent function constellate creating an analytic compass.     

Analyzing disavowed action: the fundamental resistance of analysis

Several detailed analytic hours illustrate how, with the analyst's full participation, patients use the words, setting, and activity of analysis to gratify the very wishes they are analyzing, and so disavow the work of analysis. These gratifications, which are hidden in plain sight, are themselves disavowed in the apparent pursuit of analytic understanding. In this way the patient's and the analyst's use of the analytic situation becomes the fundamental resistance to the work itself. This process shares features in common with perversion. The painful but necessary task for both analyst and patient is to analyze this process as it is occurring, moment by moment, in the real time of the hour.     

Narrative Derivatives of Alpha Elements: Clinical Implications

The author considers both the psychoanalytic field and the ways in which the characters of a psychoanalytic session can be understood. He then develops one of Bion's ideas, the dream in the waking state, by isolating the derivatives of such dreams or rather the alpha elements they consist of. The author implies a theory of technique which takes account of all the signals "the bi-personal field" gives the analyst about the functioning of the analytic couple by means of "narrative derivatives". This enables continual changes to be made in interpretation