Critical refl ections on intersubjectivity in psychoanalysis1

The authors review the philosophical trend known as postmodernism and the way it has infl uenced a part of psychoanalytic thought, concluding with some comments on the qualities and shortcomings of the new developments. The authors consider the origins and the cultural and aesthetic‐philosophical meaning of postmodernism, identifying some key concepts such as deconstructionism, the disappearance of the ‘individual subject’ and individual identity, and the rejection of ‘in‐depth’ models of psychoanalysis. Then they examine various, wide‐ranging developments in psychoanalytic thought and treatment. They review the intersubjective fi eld in psychoanalysis, especially in the USA, and then explore whether the underlying lack of truth to be discovered, stressed by these ‘new view’ statements, or the fact that the ‘truth’ only exists in linguistic‐narrative constructions is consistent with basic analytic concepts such as the unconscious, phantasy, transference and countertransference, which recall the tri‐dimensional nature of inner psychic reality. The psychoanalytic process is a condition activated through a bond that is able to hold and contain the relationship of the analytic couple and the patient's unconscious world and not through hermeneutic or narrative constructions.     

Biographical truths and their clinical consequences: Understanding ‘embodied memories’ in a third psychoanalysis with a traumatized patient recovered from severe poliomyelitis

The relationship between ‘narrative’ and ‘historical–biographical truth’ in psychoanalytic treatment has become the subject of many controversial debates in recent years. Findings of contemporary memory research have lead to great scepticism as to whether therapists are able objectively and reliably to reconstruct biographical events on the basis of their observations in the therapeutic situation. Some authors even claim that psychoanalysts should concentrate exclusively on observing the here and now of the patient′s behaviour within the transference relationship to the analyst. In this paper it will be discussed whether the baby has been thrown out with the bathwater in this debate. Centred around the insights from a third psychoanalysis with a patient who suffered from a severe case of childhood polio, the hypothesis will be discussed that working through the traumatic experience in the transference with the analyst, as well as the reconstruction of the biographical–historical reality of the trauma suffered, prove to be indispensable for a lasting structural change. Integration of the trauma into one′s own personal history and identity is and remains one of the main aims of a psychoanalytic treatment with severely traumatized patients. The reconstruction of the original trauma is indispensable in helping the patient to understand the ‘language of the body’ and to connect it with visualizations, images and verbalizations. The irreversable wounds and vulnerability of his body as the ‘signs of his specific traumatic history’ have to be recognized, emotionally accepted and understood in order to live with them and not deny them any longer. Another important aspect in psychoanalysis is to develop the capability to mentalize, in other words, to understand the intentions of central (primary) objects related to the trauma. The concept of ‘embodied memory’ might be helpful in understanding precisely in what way ‘early trauma is remembered by the body’. Observing in detail the sensory‐motor coordinations in the analytic relationship enables one to decode the inappropriate intensity of affects and fantasies which match the original traumatic interaction and are revealed as inappropriate reactions in the present, new relationship to the analyst.     

The therapeutic action of psychoanalysis

Psychoanalysis does not seek to get rid of symptoms but to question them as witnesses of psychic functioning and as formations of the unconscious. Whatever their nature may be, it is a question of analysing their causes and their functions as they appear and develop during the course of the analytic process. The latter is activated by the transference relationship induced by the method within a specific setting. The aim is to bring about liberating psychic transformations. The extension of the indications and modifications in the expression of psychic suffering have led to the development of psychotherapies. Their relations with psychoanalysis proper have been evolving constantly since the first advances by Ferenczi. This long historical evolution has resulted in their redefinition. Psychoanalytic practices are currently considered to require, depending on the case, different settings and different modes of psychic involvement from the analyst. Contemporary psychoanalysis places emphasis on the internal setting of the analyst (thus his training), analysis of the countertransference, and the risk of anti-analytic aberrations.     

Building bridges between body and mind: The analysis of an adolescent with paralyzing chronic pain

This paper describes the evaluation, initial psychotherapy and subsequent psychoanalysis of an adolescent who presented with a severe psychosomatic process involving total body pain and profound fatigue. The author details the complex and multifaceted nature of the psychosomatic process as it unfolded in the treatment. The psychosomatic problem was not a single entity, but rather was comprised of diverse interwoven elements such as somatization, conversion on pre-oedipal and oedipal levels, conflicts over aggression, sexuality, identity, masochism, secondary gain, anaclitic depression, internalized self-other interactions with a depressed mother and transgenerational transmission of trauma. The author uses the case material to discuss technical approaches to problems that often arise in the analytic treatment of patients with complicated chronic pain and fatigue as the primary complaints. Such approaches include respecting the mind-body split as a primary defense, speaking the language of the body along with the language of the mind and developing the verbal sphere around the non-verbal symptoms. The author emphasizes that complicated chronic pain problems are common and can be helped by psychoanalysis as long as the unique and complex features are understood and reflected in the technical approach.     

The clinical revolution of the ‘wise baby’

In an historical context focused on a close examination of the complex relationship between Freud and Ferenczi, the author shows Ferenczi's contribution to the evolution of psychoanalysis. He describes how his ideas and his therapeutic sensitivity anticipated modern clinical thought (for example, Winnicott and Bion), especially the understanding of borderline and narcissistic pathology. The paper considers the following topics: transference and countertransference; early affectivity; the different psychic trauma; phenomena connected with dissociation; the healing factor of the analysis.     

Ferenczi's “Confusion of Tongues” Theory and the Analysis of the Incest Trauma

Abstract

The tender-mother transference of Ferenczi's humanistic analytic orientation was as important an advance in pioneering times as was Kohut's selfobject transference in contemporary psychoanalysis. Ferenczi's clinical theory and method began a focus on pre-oedipal experiences, which eventually became an alternate to the oedipal theory. Freud was critical of Ferenczi's formulation, leading a successful attempt to suppress his work and remove it from mainstream psychoanalysis because he believed it was “regressive.” In actuality, Ferenczi's “Confusion of Tongues” theory and “Relaxation Therapy” were prophetic and pioneering attempts to understand and treat the incest trauma (ironically the clinical data upon which Freud founded psychoanalysis 100 years ago). In the case of Miss T., Ferenczi's ideas are applied to the contemporary analysis of the incest trauma.     

BECOMING RELATED: THE EDUCATION OF A PSYCHOANALYST

The author uses a “professional memoir,” a story about his first experiences in clinical work, to illustrate what he believes to be certain fundamental aspects of an analytic attitude. Taking place in a psychiatric hospital, it is meant to highlight the central place of intuition, emotional receptivity, empathy, relatedness—and their inherent dangers—in engaging therapeutically with patients' emotional disturbances. The author postulates that these and related aspects of clinical psychoanalysis are not sufficiently emphasized in psychoanalytic training and are often eclipsed by idealizations of psychoanalytic theories and their derivative techniques, third‐party demands for evidence‐based data, preoccupations with neurobiological correlates of experience, etc. Despite the clinical fact that psychoanalysis can be extraordinarily helpful to patients, he questions whether clinical psychoanalysis is rightly regarded as a “treatment.”     

The words we work with that work on us: clinical paradigm and cumulative relational trauma

This paper addresses a gap between analytic clinical theory and practice which emerges when examining the words we work with via textual and narrative research of case histories. Both subject matter and methodology fit with the remit of conceptual research in psychoanalysis, currently ranging from inductive to nomothetical approaches. Research of clinical language reveals an implicit account of human nature and the world which undergirds clinical practice. Based in the critical philosophy of the previous century, this is termed clinical paradigm. Such implicit views are induced rather than explicitly taught during analytic training, and need to be spelled out in order to become available to discourse and difference of opinion. Textual research shows these implicit pre‐clinical attitudes to be inherently pessimistic and thus too similar to the views of self and others found in cumulative relational trauma. Moreover, clinical accounts tend to normalize subtly antagonistic forms of relating, recently recognised as micro‐trauma. Importantly, this contravenes the agapic orientation of our theories and ethics. Paradigmatic reflection as a form of professional individuation addresses this gap. This includes a more optimistic outlook which can be traced through the philosophical implications of quantum theory.     

Is psychoanalysis a cheerless (Freud-less) profession? Toward a psychoanalysis of joy.

Joy can be understood as a basic form of resonance. Psychodynamically, joy is complementary to the feeling of anxiety. Whereas anxiety reflects psychic distress in connection with problems of structuring, joy is the expression of successful (re)structuring. It is the feeling of self-discovery, of a new beginning, and of self-renewal. In stark contrast, there are numerous empirically supported indications that there is little evidence of feelings of joy in the psychoanalytic literature. Why is this the case? Pursuing his analysis of this apparent but unspoken taboo against joy in professional analytic writing, the author outlines a psychoanalysis of joy in the hope that it will encourage analysts to be more aware and expressly affirmative of joy as it occurs in their work.     

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.     

David Liberman's legacy

This article presents, in the author's own vision, his attempt to consider (and update) the work of an original thinker of contemporary psychoanalysis (in the present). Following a short overview of his biographical data and distinctive traits as maestro and man, it then tries to capture the implications and panoramic vision of Liberman's work, the prevailing questions and problems of psychoanalysis to which it responds. In the author's opinion this involves a serious attempt to systematize clinical psychoanalysis on the basis of singularity and of tolerance to human diversity, with the greatest precision and scientific rigour admitted by the psychoanalytic discipline – avoiding cliché on the one hand and what we might call the mystification of the Oracle on the other. The successive stages of Liberman's production are indicated in terms of the auxiliary disciplines (communication theory, semiotics and linguistics) which he used for his ever more precise systematization of clinical psychoanalysis finally leading to his proposals on ‘style’ and his vision of the psychopathology of over‐adaptation and psychosomatic instances. Other concepts which this paper highlights are: Liberman's conception of analytic dialogue as framed by human interaction; his theorization which stems from this particular empirical base making use of ‘operational definitions’ and ‘intermediary formulations’; his operational definition of transference; and the inclusion of setting inside the ‘analytic situation’.     

Little Hans: a centennial review and reconsideration

Freud's "Analysis of a Phobia in a Five-year-old Boy" has stimulated interminable "reanalysis." The case of Little Hans, an unprecedented experimental child analytic treatment, is reexamined in the light of newer theory and newly derestricted documents. The understanding of the complex overdetermination of Hans's phobia was not possible in the heroic age of psychoanalysis. Current analytic thought, as well as distance de-idealization vis-à-vis the pioneering past, has potentiated a reformation of the case. The severe disturbance of his mother had an adverse impact on Little Hans and his family. Her abuse of Hans's infant sister has been overlooked by generations of analysts. Trauma, child abuse, parental strife, and the preoedipal mother-child relationship emerge as important issues that intensified Hans's pathogenic oedipal conflicts and trauma. With limited, yet remarkable help from his father and Freud, Little Hans nevertheless had the ego strength and resilience to resolve his phobia, resume progressive development, and forge a successful creative career.     

Vicarious traumatisation: current status and future directions

Theorists and practitioners have long recognised that working with trauma clients can trigger reactions in the therapist similar to those experienced by the client. Nevertheless, research in this area has been lacking. One obstacle has been confusion regarding key terms. Vicarious traumatisation is the most appropriate concept given that it relates specifically to trauma work, incorporates intrinsic and extrinsic factors, and can be located within the framework of the constructivist self-development theory. Although limited, research has identified a range of factors that influence vicarious traumatisation, such as experience, personal trauma history and coping style. Future investigation is required to examine aspects that could enhance counsellor resilience. In addition, vicarious traumatisation needs to be studied in terms of a broad range of clientele and occupations.     

‘To return,to eat,to tell the story ’: Primo Levi's lessons on living and dying in the aftermath of trauma

This article invites Primo Levi, the internationally esteemed citizen of Turin, Italy and survivor of the Auschwitz to instruct post 9/11 psychoanalysis in five lessons on living and dying in the aftermath of severe trauma. Relying on excerpts from Levi's writings, the author invites Levi to speak to the reader words of warning concerning contemporary psychoanalysis' benign omnipotence in embracing overly simplistic theories of cure, resiliency and psychic repatriation of the human spirit in the aftermath of severe trauma.     

Between Symbol and Antisymbol - The Meaning of Trauma Reconsidered

Within psychoanalysis, it has usually been assumed that what makes an external event traumatic is the personal meaning of the event for that individual, i.e. how it resonates within his/her internal world and in relation to the infantile conflict. Such an assumption, which implies that a trauma operates as a symbol, is compared with the contrasting view that a trauma rather destroys the capacity of symbolization, and discussed in relation to the psyche-soma issue. It is finally maintained that psychic trauma forces upon the victim a vast and difficult transformation, in relation to which the body can be used as an antisymbolic device to resist mental change.     

Revisioning Fordham's ‘Defences of the self’ in light of modern relational theory and contemporary neuroscience

This paper explores the evolution of Michael Fordham's ideas concerning ‘defences of the self’, including his application of this concept to a group of ‘difficult’ adult patients in his famous 1974 paper by the same name. After tracing the relevance of Fordham's ideas to my own discovery of a ‘self‐care system’ in the psychological material of early trauma patients (Kalsched 1996 ), I describe how Fordham's seminal notions might be revisioned in light of contemporary relational theory as well as early attachment theory and affective neuroscience. These revisionings involve an awareness that the severe woundings of early unremembered trauma are not transformable through interpretation but will inevitably be repeated in the transference, leading to mutual ‘enactments’ between the analytic partners and, hopefully, to a new outcome. A clinical example of one such mutual enactment between the author and his patient is provided. The paper concludes with reflections on the clinical implications of this difficult case and what it means to become a ‘real person’ to our patients. Finally, Jung's alchemical views on transference are shown to be useful analogies in our understanding of the necessary mutuality in the healing process with these patients.     

Editorial

Abstract

This paper will examine the current crisis in psychoanalysis in terms of the profession's decline, the apparent lack of patients, the ongoing debate over what constitutes psychoanalysis versus other therapies, and the lack of clinical focus in those debates. The concept of analytic contact will be introduced, and clinical material is used to showcase this concept as a bridge from the circular political debates to a more meaningful examination of what is psychoanalytic. In addition, case material will explore how patients tend to fight off the establishment of analytic contact in favor of safer, less threatening modes of relating. The author suggests that most patients fight off analytic contact and try to shift the treatment into something less analytic. It is up to the analyst to detect this, interpret it, and notice any countertransference collusion that may occur. Although the state of psychoanalysis as a profession is less than stellar in the eyes of the public, and the profession is apt to sabotage itself with endless debates about what constitutes true analytic work, the end is not necessary near. This paper proposes analytic contact to be the more useful focus of research and productive area of clinical exploration. If the decline of our field is to turn around, it will be on the clinical battlefront, not in terms of the theorizing among disagreeing groups of territorial analysts afraid of losing their political high-ground. The concept of analytic contact assumes that a deep exploration of intrapsychic phenomena, conflicts, and defenses, all within the realm of the transference, is the best clinical method of helping the mentally troubled individual. This genuine chance of change is best administered by a trained psychoanalyst. This simple idea is something the profession has contaminated with its often pointless arguments over frequency, analyzability, couch, and so forth. The clinical material will show that what happens in the room between analyst and patient is what best defines the true psychoanalytic treatment.     

THE VALUE OF UNCERTAINTY

The author discusses some of the characteristics of Roy Schafer's contributions to psychoanalysis that he finds most valuable, such as his openness to uncertainty, his anti‐reductive view of analytic constructions, his unique formulation of the analyst's role, and his close attention to how the patient engenders particular emotional reactions in the analyst. The author also presents a clinical vignette illustrating the value of the analyst's tolerance of uncertainty in the face of the patient's push for interpretations, explanations, and reassurance.