Early trauma and affect: the importance of the body for the development of the capacity to symbolize

In this paper I aim to outline the importance of working clinically with affect when treating severely traumatized patients who have a limited capacity to symbolize. These patients, who suffer the loss of maternal care early in life, require the analyst to be closely attuned to the patient's distress through use of the countertransference and with significantly less attention paid to the transference. It is questionable whether we can speak of transference when there is limited capacity to form internal representations. The analyst's relationship with the patient is not necessarily used to make interpretations but, instead, the analyst's reverie functions therapeutically to develop awareness and containment of affect, first in the analyst's mind and, later, in the patient's, so that, in time, a relationship between the patient's mind and the body, as the first object, is made. In contrast to general object‐relations theories, in which the first object is considered to be the breast or the mother, Ferrari (2004) proposes that the body is the first object in the emerging mind. Once a relationship between mind and body is established, symbolization becomes possible following the formation of internal representations of affective states in the mind, where previously there were few. Using Ferrari's body‐mind model, two clinical case vignettes underline the need to use the countertransference with patients who suffered chronic developmental trauma in early childhood.     

Martin Mayman's early memories technique: bridging the gap between personality assessment and psychotherapy

In this article, we describe Martin Mayman's approach to early childhood memories as a projective technique, beginning with his scientific interest in learning theory, coupled with his interest in ego psychology and object relations theory. We describe Mayman's contributions to the use of the early memories technique to inform the psychotherapy process, tying assessment closely to psychotherapy and making assessment more useful in treatment. In this article, we describe a representative sample of research studies that demonstrate the reliability and validity of early memories, followed by case examples in which the early memories informed the therapy process, including issues of transference and countertransference.     

Primordial texts: An object relations approach to biblical hermeneutics

What is object relations theory? What is the place of an object relations perspective in biblical hermeneutics as a process? After briefly introducing object relations theory, this presentation discusses the place of an object relations perspective in the hermeneutical process by analyzing D. Winnicott's “squiggle” game with childreń as a hermeneutical paradigm, and by examining critical themes such as: subject-object relations or the relationship between text and the interpreter or interpreting community, transitional space, and the suspension of disbelief or the locus of illusion in hermeneutical understanding.     

The loss of the transitional object - Some thoughts about transitional and ‘pre-transitional’ phenomena

This paper examines the use made of the transitional object in order to construct a coherent sense of self. Examples are cited from both Freud's and Winnicott's work about the use of an object to manage separations and extend a sense of self. Then some current case material is presented to make sense of the meaning of a patient's strong attachment to a negative transitional object in childhood. Its influence on her current state of mind and relationships is explored. A theoretical term, ‘the existential object’, is introduced to make sense of her use of objects. Contemporary thinking about the loss of the mother in early childhood and its influence on the sense of self is explored with reference to Andre Green's work, which is then related to Freud's and Winnicott's earlier thinking on the subject.     

The Influence of Joseph Sandler's Work on Contemporary Psychoanalysis

This overview stresses Joseph Sandler's integration of classical ego psychology with contemporary object relations theory. As part of this integration, Sandler clarified the origins and internal structure of the superego as a consequence and development of the representational world. The representational world, in turn, derives from the internalization of significant self- and object representations in the context of affect activation as fundamental motivational factors. Sandler described the transformation of internalized object relations into an unconscious template, expressed in repetitive behavior patterns, and the reactivation of its constituent object relations in the transference. In differentiating the present and past unconscious in the transference, Sandler described the role responsiveness of the analyst in the psychoanalytic situation as a specific countertransference reaction that facilitates the analysis of the object relationships activated in the transference. Sandler also explored the relationship between affects and drives and the neuropsychological capacities represented by affective and cognitive developments that jointly determine the structural characteristics of the mental apparatus.     

Dream actors in the theatre of memory: Their role in the psychoanalytic process2

The author notes that neuropsychological research has discovered the existence of two long‐term memory systems, namely declarative or explicit memory, which is conscious and autobiographical, and non‐declarative or implicit memory, which is neither conscious nor verbalisable. It is suggested that pre‐verbal and pre‐symbolic experience in the child's primary relations is stored in implicit memory, where it constitutes an unconscious nucleus of the self which is not repressed and which influences the person's affective, emotional, cognitive and sexual life even as an adult. In the analytic relationship this unconscious part can emerge essentially through certain modes of communication (tone of voice, rhythm and prosody of the voice, and structure and tempo of speech), which could be called the ‘musical dimension’ of the transference, and through dream representations. Besides work on the transference, the critical component of the therapeutic action of psychoanalysis is stated to consist in work on dreams as pictographic and symbolic representations of implicit pre‐symbolic and pre‐verbal experiences. A case history is presented in which dream interpretation allowed some of a patient's early unconscious, non‐repressed experiences to be emotionally reconstructed and made thinkable even though they were not actually remembered.     

Trauma,narcissism and the two attractors in trauma1

In this paper, the author sets out to distinguish anew between two concepts that have become sorely entangled‐‘trauma’ and ‘narcissism’. Defi ning ‘narcissism’ in terms of an interaction between the selfobject and the self that maintains a protective shield, and ‘trauma’ as attacks on this protective shield, perpetrated by bad objects, he introduces two attractors present in trauma‐‘the hole attractor’ and the structure enveloping it, ‘the narcissistic envelope’. The hole attractor pulls the trauma patient, like a ‘black hole’, into a realm of emotional void, of hole object transference, devoid of memories and where often in an analyst's countertransference there are no reverberations of the trauma patient's experience. In the narcissistic envelope, on the other hand, motion, the life and death drive and fragments of memory do survive. Based on the author's own clinical experience with Holocaust survivors, and on secondary sources, the paper concludes with some clinical implications that take the two attractors into account.     

CONTAINING,TRANSLATING, AND INTERPRETIVE ACTING OUT

In analytic treatment, when patients project unspoken aspects of their internal self and object world, the analyst has to find ways to understand and communicate those expelled phantasies without the patient feeling accused, seduced, or persecuted; even when we do our best at interpreting such inner conflicts, the patient may experience our interpretations as assaults, forcing them to give up themselves or their hope for reconnecting with an object. The patient will resist or fight our efforts through the use of projective identification. Caught up in patient's projections, the analyst in turn may enact some of these phantasies by becoming the object rather than translating its presence in the transference, by overemphasizing one side over another of the patient's conflict, or by interpreting accurately but prematurely. These issues are illustrated in two case presentations and discussed in relation to the views of contemporary Kleinian writers on transference and countertransference.     

Aloneness and borderline psychopathology: the possible relevance of child development issues.

The experience of intense painful aloneness is a common event in the lives of borderline patients, especially those closer to the psychotic spectrum. This experience is defined as an intrinsic aspect of the borderline personality defect and consists of a relative or total inability to remember positive images or fantasies of sustaining people in the patient's present or past life, or being overwhelmed by negative memories and images of these people. The development of borderline aloneness is related to a possible developmental failure, defined by Piaget, Fraiberg, and A.-M. Sandler. These workers describe the child's development of object permanence and evocative memory capacity (Piaget's sensori-motor stage VI). We postulate that a major borderline vulnerability is the tenuous achievement of the capacity for affective object permanence and its regressive loss to recognition memory or earlier when under specific stresses. We relate our hypotheses to possible empathic parental failures during the substages of separation-individuation, especially the rapprochement sub-phase. The treatment implications of our formulations are discussed, with an emphasis on the clarification of the need for the therapist's availability and the use of transitional objects during times of the patient's loss of his affective cognitive capacities. These regressive experiences often emerge as a core transference manifestation during psychoanalytic therapy with borderline patients, and often become the basis of significant therapeutic work.     

Psychoanalytic identity and the external world: Interaction between psychoanalysis and health service systems in Sweden

Abstract

This paper continues the exploration of the clinical phenomenon of analytic contact. The author demonstrates, through case material, the essential ingredients of psychoanalysis to be not frequency or use of the couch, but rather the moment-to-moment analysis of the patient's transference state and phantasies of what it means to establish relational contact with their objects and with themselves. The nature of the treatment can be shaped, prevented, perverted, or fostered by the patient's phantasies and unconscious conflicts into something more analytic or less analytic. Interpretation needs to include the exploration of the patient's attempts to change the treatment into something that is often a replica or a repetition of archaic object relations. The typical patient in psychoanalytic treatment is struggling with rather profound pathology and as such tends to create a significant stand-off with the analyst when analytic contact is forming. Analytic contact is often threatening to these patients in very primitive and alarming ways that must be gradually understood and interpreted if the treatment is to survive and remain a primarily analytic journey rather than be transformed into a more supportive counseling or a pathological re-enactment of conflictual phantasy states.     

Parent–child relationship quality and infantile amnesia in adults

The first years of life are typically shrouded by infantile amnesia, but there is enormous variability between adults in how early and how much they can remember from this period. This study examined one possible factor affecting this variability: whether the perceived quality of parent–child relationships is associated with the number of early memories young adults can retrieve, and their age at the time of their first memory. We found such associations but they were qualified by parent gender. Mother–child relationships that were more affectively intense (greater social support but also more negative interchanges) were associated with recalling more early memories, although paternal companionship was most associated with how early an individual's first memory was. Affective tone of retrieved memories was also assessed, and a greater proportion of affectively positive memories (as well as fewer affectively neutral memories for males) was associated with high parental involvement in children's lives.     

Transference in the rat man case: the transference in transition

This study has concentrated on the use of the transference concept in the Rat Man case as a method for revealing repressed memories and to gain conviction about these repressed memories. In this treatment-transference model, transference interpretations focusing on the analyst are not germane, since the transferences are merely the vehicle by which memories are uncovered. Thus, Freud's transference work in 1907 revealed a transitional phase of his clinical activity soon to be supplanted by later insights into the curative aspects of transference analysis.     

Seeing and Being Seen: Courage and the Therapist in Cross-Racial Treatment

ABSTRACT

Correction of the patient's distortion is often the focus of therapeutic treatment. However, the therapist's distortions, based upon pre-existing fears, which themselves are often rooted in greater societal issues and energized by the work with the patient (especially as they relate to issues of racial difference between the therapist and patient), can lead to clinical impasse. Just as an effective treatment relies upon the patient's opening up to correcting distortions, so too the therapist must be able to use transference response and become vulnerable to knowing and moving beyond his own fears and distortions.     

SOME VIEWPOINTS ON WOMAN'S INNER SPACE

In this paper, illusion is examined as a prerequisite and necessary medium for the analysand's finding the genuine subjective reality of his own in the psycho-analytic interaction. Two kinds of illusion are discussed The first of them, transference illusion, is well-known, as is its understanding as a simultaneous existence of experiences stemming from different levels of reality. At its side, the author introduces the concept of developmental illusion, as an essential constituent of the analytic process. As contrasted to transference illusion, the wishes inherent in a developmental illusion have never become meaningfully represented in the analysand's mind. These interrupted developmental needs attaining shape and meaning, and thus the possibility to develop further in the analytic relationship, is dependent on the analyst's ability and ways to receive and meet the analysand's activated developmental illusion. The rôle of the analyst's ways to reach and convey his understanding is considered decisive in this process.     

Three Phases of Treatment with Borderline and Psychotic Patients

Three distinct, yet overlapping, phases of treatment emerge when working with some borderline and psychotic patients. This are patients who test the ordinary limits of psychoanalysis, but can profit from its deep exploration. The first phase is colored by acting out, interpersonally and intrapsychically. An analytic envelope of containment is necessary to sustain the treatment. Interpretive holding and containing help the patient find a psychic receptacle capable of detoxifying violent projections. Many of these patients terminate prematurely. The second phase is centered around the patient's defensive use of the death instinct to extinguish or destroy certain parts of their mental functioning. This difficult standoff between parts of the patient's mind becomes replicated in the transference. The third phase reveals the more fundamental problem of paranoid～schizoid anxieties of loss and primitive experiences of guilt. These include fears of persecution and annihilation. Some patients abort treatment in the first or second phase and never work through the phantasies and feelings of loss. Nevertheless, much intrapsychic and interpersonal progress is possible. Given the instability and chaotic nature of these patient's object relations, the analyst must be cautiously optimistic in their work and realize the potential to help the patient even when presented with less than optimal working conditions.     

A Case Study: A Discussion of Depression,Ambivalence, Attachment,and Culture Portrayed in the Therapeutic Environment

ABSTRACT

This paper uses object relations theory to conceptualize and manage the complexities of a home-based case that was followed for a period of six months. It discusses maternal depression in relation to the caregiver role, self-harm, and self-determination. The client's ambivalence issues are addressed, with particular emphasis on transference and countertransference issues in the relationship and the use of transitional space and objects. Also discussed is the effect of maternal depression and ambivalence on mother-infant attachment, with the introduction of interaction-guidance as a treatment modality. An examination of cultural differences and the concomitant ethical implications that arose in the treatment process is provided. Finally, therapeutic implications and reflexivity are addressed.     

Alter(ING) Potential Space: Personalization and Community in Psychoanalytic Therapy

In this paper, I use the notion of alterity to amend Winnicott's view of potential space. I suggest that the parent's potential space—omnipotent recognition and treatment of the baby as person—makes possible the baby's belief in and experience of omnipotence, which is manifested in his/her omnipotent recognition and treatment of objects in terms of utility, pleasure, and function. This early manifestation of potential space gives way to recognition of objects as proto-persons, which accompanies the child's illusion that the (transitional) object recognizes him/her as a person. Here the child learns to surrender to the object's omnipotent constructions and, in these moments, there is a proto-communion—an illusory experience of mutual joining together as persons. This eventually gives way to a potential space wherein two or more people mutually and omnipotently construct and surrender to each other as persons, subordinating pleasure, function, and utility to the recognition of the Other as person. This depiction of potential space can serve as a framework for understanding the process of therapy as a struggle not simply of reality and illusion, but one of recognition and treatment of Others as persons and the possibility of communion and community.     

MIND AND ITS TREATMENT

On the basis of mother-baby observations and analytic experience, it is argued that a trauma during infancy leads to a psychic functioning where the early defensive manoeuvres of non-integration described by Eugenio Gaddini cannot be given up in fear of a repetition of the catastrophe, already experienced once in early infancy, of losing the self. This state of non-integration can be seen in a traumatized girl's missing feminine symbolizations as well as in her false self. A girl is described who had to stick to a transitional object, which seems to represent concretization, an inablity to symbolize, instead of being able to use a transitional phenomenon supporting healthy development. A case of a hysteric woman illustrates the state of non-integration due to an evident early trauma. For women, as in this case, the female inner-genitality has to be filled with pregenital drive-contents. The binding functions as well as the symbolization function are paralysed due to integration-anxiety. In analysing the resistance of my patient, I have found an active use of imitation for the purpose of self-defense within the transference against receiving the analyst's understanding, empathy or interpretations. This state of non-integration, possibly typical of hysteria, is what Gaddini calls imitative identity.     

MAPPING THE LANDSCAPE: LEVELS OF TRANSFERENCE INTERPRETATION3

The author argues that there are distinctly different kinds of transference interpretation, each of which might be valid in particular circumstances in analysis, but which contain and imply different understandings of what is meant by a ‘transference interpretation’. She suggests that transference interpretations may be at any one of four different levels, and she describes these levels as ranging from interpretations that point to links between current events in the analysis and events from the patient's history, through interpretations that link events in the patient's external life to the patient's often unconscious phantasies about the analyst and the analysis, to interpretations that focus on the use of the analyst and the analytic situation to enact unconscious phantasy configurations, sometimes pulling the analyst into the enactment. Material from four consecutive sessions of an analysis is presented to illustrate how all levels of transference interpretation may be part of a lively and meaningful analysis, but how the level of interpretation may change as the level of understanding deepens within a session and from one session to the next.