The Principle of Necessity,and the Necessity of Principle: Commentary on Steven Stern’s Paper “Holistic Thinking and Therapeutic Action: Building on Louis Sander’s Contribution”

Steven Stern’s principle of necessity underscores the importance of being open to the emergence of something new, something therapeutically vital and alive to both patient and therapist, requiring a unique alertness to the unbidden, the previously not-thought-about, the on-the-edges-of-our-experience type impressions in the course of living through the otherwise familiar and the usual. This commentary addresses Stern’s principle of necessity and, equally so, the continuing necessity of principle in analytic work—a kind of ongoing sensibility that argues for placing aside theoretical knowledge and intervention categories in favor of striving to be open to the emergence of the unusual and the unexpected, to what ultimately proves therapeutic. We strive to work at and tolerate suspending our preconceptions, our theories, and our assumptions about how things should unfold in the clinical setting—what is referred to as analytic courage.     

Reclaiming the Boundary Concept from Forensic Discourse: Response to Commentaries

The author argues that sexual misconduct is better referred to as ethical or sexual misconduct rather than combining a fragile metaphoric construct—boundary—with forensic jargon. His argument rests on a few points that intersect. One objection to the term “boundary violation” involves a matter of scale in which the notion of exploring psychic boundaries, the essential context for psychoanalysis, is obliterated by sexual misconduct. The enormous scale of sexual misconduct is better labeled with behavioral referents rather than a moniker that combines forensic violation and the subtleties of analytic process. The author would reserve the term boundary difficulties for analytic process related to more subtle problems in analysis and the use of boundaries embedded in the work. Another objection relates to our responsibility to those outside our community to refrain from using our sophisticated understanding of the play of boundaries in analytic work in ways that are too often unintentionally confusing and mystifying.     

Re-enchanting the body: overcoming the melancholy of anatomy

I argue here that Weberian disenchantment is manifest in the triumph of instrumental reason and the expansion of analytic enquiry, which now dominates not simply those sciences upon which medicine depends, but medical practice itself. I suggest ways that analytic enquiry, also referred to here as anatomical reasoning, are part of a particular ideology—a way of seeing, speaking about, and inhabiting the world—that often fails to serve the health of patients because it is incapable of “seeing” them in the moral sense described by Iris Murdoch and others. I use the work of James Elkins and Wendell Berry to call for the recovery of a way of seeing the human body as both other and more than an object of scientific enquiry and social control.     

Reforming Theology,Reframing Science

Abstract : What is the role of science in theology? What internal dynamics compel theology to take science seriously? Those are the questions—posed in a characteristically cautious academic fashion. There is a back‐story that needs to be told, however, if we are to get at these questions with the vigor they require: Without radical reformation of theology, there is little chance that we can even begin to work on the agenda that science poses to Christian faith and life. Faith is a journey in which we seek to make sense of the world and our lives in it in the light of the gospel we have received. The gospel is about God, God's presence and redemptive work in Jesus Christ and God's continuing presence in the Holy Spirit. But since it is God's presence and work in the world and for us, the gospel is also about the world and about human being—and that is where science comes in, provoking its reformation. Science is now an irreplaceable source of knowledge about the world and ourselves, and in some respects its knowledge is normative. Scientific knowledge has reshaped our view of the world and ourselves in ways that are so commonly known that it is unnecessary to elaborate. To relate our gospel to our actual lives in the empirical world—that is theology's motivation for taking science seriously. But theology must be reformed and reshaped if it is to be capable of taking science seriously. In this essay we focus on this reforming of theology.     

INTUITING THE TRUTH OF WHAT'S HAPPENING: ON BION'S “NOTES ON MEMORY AND DESIRE”

Bion's “Notes on Memory and Desire” (1967a) is an impossible paper that this article's author has struggled with for decades. He views the paper, only two and a half pages in length, as a landmark contribution. Despite its title—and its infamous dictates to resist the impulse to remember past sessions and desire for “results”—the paper is not, most importantly, about memory and desire. It proposes a new analytic methodology that supplants awareness from its central role in the analytic process and, in its place, instates the analyst's (largely unconscious) work of intuiting the (unconscious) psychic reality of the present moment by becoming at one with it. This article's clinical examples, provided from the author's own work, illustrate something of his ways of talking with his patients.     

Only connect: Developmental issues from early to late life

Summary

This paper links aspects of early experience and developmental processes (especially the Oedipus Complex) to troubled states of mind, both in later life and, at length, in the mental predicament of the very elderly — especially in relation to confusion and dementia. The paper draws on psychoanalytic and observational literature, and also on infantile developmental research to trace the ways in which capacities more familiar in the care of infants and young children are especially relevant in extreme old age — eg an understanding of containment, reverie, projective identification, splitting and denial, etc. through a series of detailed observations from within a single family, the paper explores the ways in which psychoanalytic knowledge of early ‘childishness’ may contribute very immediately, even technically, both to an understanding of ‘second childishness’ (to draw on As You Like It) and to how to work therapeutically with these enfeebled states of mind.

Last scene of all, that ends this strange eventful history, Is second childishness and mere oblivion, Sans teeth, sans eyes, sans taste, sans everything.     

Review Essay: Constructivism with a Human Face

Irwin Hoffman's book Ritual and Spontaneity includes, but goes well beyond, his series of seminal papers—written over the past several decades—developing a psychoanalytic, constructivist perspective. A new, existential framework depicts what Hoffman calls the “psychobiological bedrock” at the core of the human process of constructing meaning—the lifelong effort to create a livable, subjective world in face of our ever present sense of loss, suffering, and, ultimately, mortality.

This review describes Hoffman's encompassing, existential perspective and discusses how, within this framework, he uses his dialectical sensibility to frame our understanding of both parenting and analysis as “semisacred” activities. The “dialectic of ritual and spontaneity”—the vital clash between disciplined adherence to the analytic frame and personally expressive deviations from it—represents the creative tension between the “magical” dimension of analytic authority and the healing influence of a genuinely expressive human relationship. Hoffman's perspective on the self-interested, “dark side” of the analytic relationship is compared with Winnicott's views on the vital, therapeutic role of “hate” and the paradoxical process by which the patient comes to “use” the analyst.

Unlike most postmodernist “constructivists,” Hoffman openly reveals his underlying belief in certain “transcultural, transhistorical universals”—his “psychobiological bedrock.” In acknowledging these “essentials” (assumptions about human nature) that in some form are integral, yet often hidden, elements of any system of thought, Hoffman saves his own dialectical constructivism from falling into dichotomous (constructivist vs. essentialist) thinking.     

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.     

Affective Honesty and Compassion Come in Many Forms: Discussion of “Love (and Hate) With the Proper Stranger: Affective Honesty and Enactment,” By Holly Levenkron,L.I.C.S.W.

Holly Levenkron's work with her patient, Ali, beautifully illustrates one way that a creative analyst makes superb use of her own experience to communicate and negotiate with great affective honesty. Holly's analytic style emphasizes the effective use of a particular kind of self-disclosure and a way of thinking about intersubjectivity and enactment associated with the contemporary Relational movement. Yet, it may be Holly's personal willingness to allow the analytic relationship to profoundly destabilize and influence her that most engages Ali in their work.

An imaginary analytic scenario is described with an analyst, Dr. X, who like Holly is destabilized by Ali but whose thinking about intersubjectivity and enactment emphasizes an empathic immersion in Ali's experience of the analytic relationship. In contrast to Holly, Dr. X focuses primarily on grasping and interpreting the adaptive strivings that animate Ali's differently organized subjective world.

The underlying capacity to acknowledge and use the analyst's own version of the patient's issues may also characterize analyses such as that of the hypothetical Dr. X—in style that are more explicitly “interpretive” (less confrontative) than Holly's work. These two contrasting approaches highlight the wide range of ways to think about intersubjectivity, enactment, and affective honesty in the analytic process.     

The Importance of a Comprehensive Clinical Diagnosis for Group Psychotherapy of Borderline and Narcissistic Patients

This article presents a psychoanalytically oriented model of group treatment for female adult survivors of childhood sexual abuse. Two key treatment, issues—the survivor's struggle to trust her own mind and her tenacious allegiance to an omnipotent, all-bad self-representation—are used to illustrate ways in which the transference/countertransference matrix of the group permits members to enact, identify, and work through central internalized relational configurations. The group therapist's role is to maintain transitionality, a focus on process, and the capacity for play.     

Field of Vision: Radical Uncertainty and the Analyst's Conduct: Commentary on Paper by Donnel B. Stern

There is a relationship between biography and theory. The analyst's ideas or formulations about his patients—theories really—must be determined, to some degree, by the certain and uncertain impact of his own history. Harry Stack Sullivan brought psychoanalysis squarely into the ambit of the relational/historical world by insisting that the mind is thoroughly and inherently social. In doing so, he staked a claim for the link between history, that is, social experience, and personhood. Our personalities and our theories are social-historical constructions. In relation to this, some differences between the interpersonal/relational and Bionian concepts of field theory are provided. One important difference pertains to the role of the analyst's conduct. Two meanings of conduct—to behave or to organize behavior—are at the center of what distinguishes the interpersonal/relational view of the analyst's position in the field from the Bionian view. For the relational analyst, action in the analytic field, including enactment, is conduct, and conduct is always bidirectional. The analyst, then, is a medium to alter, to reconstruct the self. He does not provide experience, he is experience. The form of an analytic exchange gives shape to the field and its content.     

The Analyst's Secret Delinquencies

Despite a burgeoning literature on major analytic boundary violations, there has been little investigation of what might be called analytic delinquencies or misdemeanors—the small and virtually ubiquitous ways in which analysts deliberately withdraw from the therapeutic endeavor. I consider the impact of professional misdemeanors on patient and analyst and compare both with more serious analytic “crimes” and enactments. Professional delinquencies may reflect a therapeutic reenactment, an expression of the analyst's split-off or disavowed need, or an unconscious attempt to self-regulate or to negotiate space within the constraints of the treatment setting. Because the professional ideal leaves so little room for the analyst's humanity, it is often difficult for us to address and work with evidence of our own need when it clashes with what we regard as the analytic contract.     

Introduction

This introduction presents the work of three colleagues—Stephen H. Cooper, Ken Corbett, and Stephen Seligman—writing on the importance of reverie, silence, internal work in and by the analyst as a crucial interface with relational and intersubjective analytic work. All three consider their work an engaged critique of the focus on action and interaction in relational accounts of process. The panel includes commentary by Anthony Bass and Donnel B. Stern and a collective response to the discussions by Cooper, Corbett, and Seligman. This introduction considered the potential for internal critique within a relational community, considers the group process in which critique may be produced, and encourages the development of ways of exploring difference.     

The Other Game: A Journey into the World of Warcraft

ABSTRACT

Many people today live out significant aspects of their internal lives online, in a digital world. Rather than analyze these worlds as mere metaphors for real life, it has become increasingly important for psychotherapists to be willing to participate in these worlds as they are described during the clinical hour. It is necessary to work within a paradox: An online fantasy world takes away from living life in the outer world; the world online offers the safety necessary to help the patient approach living his life in any world. This article explores a case in which I learn to work within the parameters of an online gaming experience—World of Warcraft?—to help a patient integrate split-off aspects of himself as he develops the capacity to own his desires. In this case, the game functioned as an “Eden project” (Hollis, 1998, p. 33), an earnest, if severely constricted, search for paradise lost. This article illustrates what was found—not Eden, but true Otherness.     

An Elegy,a Love Song,and a Lullaby

In the course of the past decade, I have found himself looking as much to poets and the experience of reading poetry as to the work of other analysts in my ongoing effort to become a psychoanalyst. Both the poet and the psychoanalyst are individuals whose life's work is that of making “raid[s] [on] the inarticulate” (Eliot, 1940, p. 128) in their effort to delve as deeply as possible into what it is to be human and to render that experience in the medium of language. To this end, I offer a reading of Seamus Heaney's (1987) “Clearances,” an elegy Heaney wrote for his mother soon after her death. I explore the ways in which the experience of mourning—whether in a poem or in an analytic experience—is not simply “conveyed” (as if illuminating something already there) but created in the very act of writing/saying the poem or of bringing feelings to life in words in an analytic session.

I begin by presenting a brief biographical account of Heaney not to “explain” his poetry in analytic terms but to allow the reader to create a more imaginative, more human reading of the poem as he or she enters into the conversation between the life of the man and the life of the poetry. Then I discuss the ways in which “Clearances” comes to life as a variety of coexisting forms of love that together shape an experience of grief.     

IRIS MURDOCH AND THE BORDERS OF ANALYTIC PHILOSOPHY

Iris Murdoch's philosophical texts depart significantly from familiar analytic discursive norms. (Such as the norms concerning argument structure and the minimization of rhetoric.) This may lead us to adopt one of two strategies. On the one hand an assimilation strategy that involves translation of Murdoch's claims into the more familiar terms of property‐realism (the terminology of ethical naturalism and non‐naturalism). On the other hand, there is the option of adopting a crossover strategy and reading Murdoch as (in some sense) a philosopher who belongs more properly to the continental tradition. The following article argues that if familiar Quinean claims about ontological commitment and Murdoch's account of metaphor are both broadly correct then the assimilation strategy must fail to produce a faithful translation. Nonetheless, Murdoch's connection to the analytic tradition is more than genealogical, it is more than a matter of her writing (initially) in response to analytic contemporaries before branching off in a more continental direction. While she departs from familiar analytic discursive norms, she continues to accept most of the epistemic values (such as clarity and simplicity) that the norms embody.     

Apocalyptic themes in times of trouble: when young men are deeply alienated

Boys and young men more frequently live out aspects of their psychic and social alienation online. This paper explores some of the risks and dangers that can arise from retreats into the two-dimensional world of cyberspace. It focuses more specifically on videogaming called MOBA, multi-player online battle arena games, in which players point and shoot at others. A case example emphasizes the clinical problems emerging from violent fantasies that seek a false form of containment in cyberspace. Themes of destructive fantasizing are further amplified through images of apocalypse, which are often prevalent in combat arena videogames. Textual sources from the Book of Revelation offer possible understanding for various elements of destructiveness as it appears in vulnerable male psyches. Therapeutic contact that combines a relational, containing approach and a broadly spiritual and soulful perspective can provide a path to healing such violent splits within the psyches of boys and young men.     

THE EXPERIENCE OF HOME AND THE SPACE OF CITIZENSHIP

I argue that, although we are inherently intersubjective beings, we are not first or most originally “public” beings. Rather, to become a public being, that is, a citizen—in other words, to act as an independent and self‐controlled agent in a community of similarly independent and self‐controlled agents and, specifically, to do so in a shared space in the public arena—is something that we can successfully do only by emerging from our familiar, personal territories—our homes. Finding support in texts from philosophy, psychology, and the social sciences, I construe the claim that citizenship is a developed stance as a spatial issue. I conclude that a state (or, for that matter, a philosophy) that takes the human being to begin as an isolated individual agent fails to recognize the essential spatial relationships on which we depend—namely, those arising through our way of being‐at‐home in the world; and, as a result, such a stance not only misconstrues the parameters on which citizenship is itself possible but also risks developing a social situation that encourages behaviors we see in the agoraphobic—namely, the behaviors of alienated and fundamentally homeless human beings.     

The Reality Principle: Fanonian Undoing,Unlearning, and Decentering: A Discussion of “Fanon’s Vision of Embodied Racism for Psychoanalytic Theory and Practice”

This response argues that attention to the ideological misattunements in psychoanalytic work helps us move beyond the symbolic—and that which it hides—into the real, material implications for our patients. By discussing Waverley’s hyper-corporality especially in relation to Knoblauch, his White analyst, we can mark a real vs. symbolic recognition of the expansiveness of Whiteness and the ways in which it aims to recenter itself in our theory, practice, and training. More specifically, using Knoblauch’s (this issue) moving account of a moment of “misrecognition,” this response takes up the ways in which Whiteness materializes an ideological apparition that aims to invert the visible-invisible spectrum.