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.     

Full and empty spaces in the analytic process2

In this paper the author discusses two categories of patients which differ in terms of the impact they have in the countertransference. On the one hand, there are patients who create an empty space in the analyst's mind. The response they provoke is a kind of depressive feeling that remains after they leave. The patient may bring dreams and associations, but they do not reverberate in the analyst's mind. The experience is of dryness, a dearth of memory, which may‐at times‐leave the analyst with a sense of exclusion from the patient's internal world. At the other extreme, there are patients who fill the consulting room. They do that with their words, dreams and associations but also with their emotions and their actions. The experience is that the analyst is over‐included in the patient's world. They have dreams that directly refer to the analyst and the analyst feels consistently involved in the patient's analysis. The pathway through which the analyst can understand both these types of patients is via the countertransference or, to put it another way, the analyst's passion. In ‘Analysis terminable and interminable’ Freud suggested that the bedrock of any analysis is the repudiation of femininity. The author believes this statement may be viewed as lying at the crossroads of the discussion about the limits of the theoretical and clinical psychoanalytic formulations which she refers to. In the examples presented the author relates the repudiation of femininity in its connections to the gaps implicit in psychoanalytic understanding.     

AN ANALYST'S UNCERTAINTY AND FEAR

The motivations for choosing psychoanalysis as a profession are many and differ depending on the psychology of the analyst. However, common to most psychoanalysts is the desire to forge a helpful relationship with the individuals with whom they work therapeutically. This article presents an example of what happens when an analyst is confronted by a patient for whom being in a relationship and being helped are intolerable.     

The Analyst’s Private Space: Spontaneity,Ritual, Psychotherapeutic Action,and Self-Care

The contemplation, containing, and linking that circulate within the analyst’s private space are positioned as key to states of psychic equivalence (the melding of psychic reality and material reality) and to sustained states of unknowing, which are held to be necessary for analytic work and fantastic spontaneity. These modes of practice are considered as they relate to rituals that promote the analyst’s self care. An account of a psychotherapy with a 5-year-old electively mute girl is offered to illustrate the work undertaken in the analyst’s private space, as he seeks to build and sustain potential space and the possibilities borne through play.     

Finding our way in perplexity: the meanings of sex in the analysis of a gay man.

As preconceptions about the meaning of sexual orientation are increasingly abandoned, analysts are left with the question of how these matters are to be addressed in clinical work. These problems are explored as they emerged in analytic work between a "gay" man and a "straight" analyst. Emphasis is placed on how the search for personal meaning is impacted by the intellectual and social context inhabited by analyst and patient.     

Die institutionelle und die innere Familie des Analytikers

The author postulates the existence of an intense interaction between the analyst’s two families, the historical one of his infancy and the institutional one of his psychoanalytic education. In his opinion they both step into the analyst’s work with his patient on the level of his inner fantasy and to different degrees according to the various moments in the work. He points out that the common element between the infantile experience and the analytic one is the enormous opportunity for profound introjection. There are important moments that favor introjection in the young analyst’s training course which establish and constitute the cultural, theoretical and clinical foundations of his working ego and of his working self. The importance of a thoroughly analyzed separation process from the personal analyst and from the supervisors during the analysis is strongly emphasized.     

Essential content for training behavior analysis practitioners

A recent national survey of 265 behavior analysts has produced a list of 12 content areas and 108 tasks that the group felt were essential in the training of behavior analyst practitioners. The survey methodology, sample demographics, and survey results are summarized. The implications of these results are discussed as they relate to instruction in behavior analysis and the standards of practice of behavior analyst practitioners. The final task list of essential content is provided.     

Finding unconscious phantasy in the session: Recognizing form

The concept of unconscious phantasy has played – and still does play – a central role in psychoanalytic thinking. The author discusses the various forms by which unconscious phantasies manifest themselves in the analytic session as they are lived out and enacted in the transference relationship. This paper also aims at expanding the kleinian theory of symbol formation by exploring the impact that emotional aspects connected to early “raw’, “pre‐symbolic’ phantasies have in the analysis and how their corporeal elements interlock with the signifying process. The author follows the expressive forms of primitive unconscious phantasies as they appear in a psychoanalytic session and proposes that the emotional effect that can be experienced in the communication between patient and analyst depends in great measure on “semiotic’ aspects linked to primitive phantasies that are felt and lived out in embodied ways. Rather than a move from unconscious phantasies that typify symbolic equations to those showing proper symbolization, these can coexist and simultaneously find their way to what is communicated to the analyst. As early phantasies bear an intimate connection to the body and to unprocessed emotions when they are projected into the analyst they can produce a powerful resonance, sometimes also experienced in a physical way and forming an integral part of the analyst's counter‐transference.     

“With you I’m Born Again”: Themes and Fantasies of Birth and the Family Circumstances Surrounding Birth as These are Mutually Evoked in Patient and Analyst

Themes of birth and rebirth, being born and born-again, can be readily observed in clinical psychotherapy and psychoanalysis even as they remain undertheorized. A clinical case is presented that traces the first four years of an analysis as seen through the lens of four consecutive supervisory experiences. This paper explores the central importance of fantasies and narratives of one’s origins and birth and the observations, fantasies, and expectations generated by one’s family circumstances at the time of birth. The paper examines birth narratives, fantasies, and myths of origination by following a clinical case across four supervisions. The patient’s birth-related fantasies are shown to interact with the analyst’s concordant and complementary fantasies as the analyst interacts with a series of supervisors in the process of being born as an analyst. The analyst’s personal birth narrative is linked to his fantasies about being born professionally as an analyst, and these are shown to interact with the patient’s birth fantasies. The paper suggests the ongoing significance of unconscious fantasy within the framework of contemporary relational psychoanalysis.     

Hearing voices: the fate of the analyst's identifications.

Using detailed clinical examples, the author illustrates the function of conscious and unconscious identifications with former training analysts, supervisors, teachers, and theorists in the mind of the working analyst. As compromise formations, analytic identifications are the product of loving and aggressive wishes, defenses against those wishes, and self-punitive trends that accompany the analyst in the work. The analyst's stance at any given moment has an identificatory history that may become conscious at certain times with certain patients. While the analyst's identifications modify over time, following a predictable developmental path, they are never fully given up, but consciously and unconsciously remain an active part of the analyst's inner life. During the clinical hour they are responsive to both the analyst's and the patient's conflicts, and they coexist in a dynamic reciprocal relationship with the patient's inner life.     

Waking the Dead Therapist

The treatment of persons with dissociative adaptations is often filled with the stirring and emergence of intense affective states. Often bereft of words, these affective states remain to be articulated by either patient or analyst, as best they can tolerate. I present a case to illustrate the ongoing struggle in a countertransference analysis of unbidden and initially uncontrollable sleepiness in the analyst as a pathway toward greater understanding of intense affects in both patient and analyst. The benefits and risks of disclosing the analyst's subjective experience is explored.     

On gratitude and gratification

Expressions of gratitude from the patient may be regarded by the analyst as a much-needed validation or affirmation of competence. The analyst's need for gratitude may be a relatively silent presence when things are going smoothly or when the analyst's efforts are openly appreciated by the patient. Ungrateful patients, however, are likely to force the analyst to confront his or her unconscious background wish to enact a longed-for mode of relatedness as part of the daily work of psychoanalysis. The analyst's wish for a specific form of object relationship involving a selfless, devoted helper and an appreciative patient who acknowledges having been helped may be thwarted by certain patients at every turn, knowing they are depriving the analyst of a particular form of gratification in their work. For patients of this type, failure may mean success. The implications of this particular form of clinical stalemate are outlined, and a clinical example illustrates some of the challenges encountered in psychoanalytic work with ungrateful patients.     

The dark side of analytic conviction: impasses of omniscience and complacency

It is common for analysts to struggle with substantial periods of impasse, and with the associated subjective feelings of shame and failure, while analyzing patients who rely heavily on narcissistic defenses. Facing the feelings that accompany periods of impasse, while at the same time pushing oneself to take necessary creative risks, is a huge and painful task for the analyst if it is deeply confronted. These patients engage in false uses of the analytic process in which the pursuit of understanding is systematically undermined. In response, the analyst is susceptible to being drawn in to processes of mutual seduction, false conviction, and impasse. Through the analyst's partial living out of the patient's projective identifications (and eventually observing the patient's living out of the analyst's projective identifications), the analyst is able to gain a depth of understanding of the patient, of him- or herself, and of the interaction that might not otherwise be possible. Because analysts tend to employ theory defensively, it is essential that they attend, through self-analysis and consultation, to the ways in which they use it. Two cases are presented in which prolonged impasses were eventually understood and resolved.     

Infantile Trauma,Therapeutic Impasses and Recovery

Throughout his writings Ferenczi examines the role of the mother–infant relationship in healthy development as well as the difficulties that occur when that relationship is problematic. This paper using Ferenczi and Bion as theoretical background explores the clinical development of impasse in the treatment of hard to reach patients. These patients present special difficulty for analysis because they are not self reflective although they can be addicted to “processing,” which is in lieu of emotional connection. Impasse occurs when the analyst does not detect the mimicry involved in processing. The paper offers the idea of recovery, rather than repair, in that such patients have “gone missing” in infancy. Recovery of lost potential can be found in relationship with the analyst and with significant others.     

External and internal reality: The impact of the current socio‐economic crisis on the analytic dyad

This paper addresses the impact of the current economic crisis on the psychic functioning of the patient and the analyst, their relationship and collaboration. This intrusion of ‘external reality’ is multidimensional, and thus with multiple meanings. The critical role of the economic factor brings various dimensions of money into play, such as self‐preservation, power as well as aspects of psychosexual development. In addition, the crisis involves symbolic loss of basic ideals such as honesty and social responsibility. Patient and analyst are affected in similar and different ways in their respective roles as well as according to the specific intrapsychic functioning of each. Moreover, unique characteristics of the crisis often create a crisis in the analysis. In order to avoid deformation of the analytic relationship, the analytic dyad must examine and work through the multiple meanings of the crisis as well as the meaning of the impact of the crisis on the analytic relationship for both patient and analyst. This complex transference‐ countertransference interplay poses specific challenges to the analyst. After discussion of these issues, clinical material is presented that demonstrates how they appear in analytic practice today.     

Making Good Use of Combined Therapeutic Modalities: Discussion of “Somatic Experiencing”

A positive view is taken of integrative analytic and bio-psychological Somatic Experiencing (SE) therapy for trauma. Levit’s case report is viewed as reflecting an early stage of the analyst’s development as an integrative clinician. A risk of integrative treatments is splitting between modalities of analytic functions including affect regulation. The present case is read closely. Commentary focuses on enactment and missed opportunities for analytic reflection, including (transference) meanings of SE interventions. Increased analytic attention to therapeutic process aims to open reflective space to discuss a wide range of experiences in treatment, including disappointments and other (more negative) aspects of transference, deepening the therapeutic experience, and reaching more broadly into sequelae of the patient’s developmental trauma than SE intervention alone. Integrated bio-psychological interventions are compared and contrasted with use of psychotropic medications in analytic therapy. Bio-psychological interventions such as SE have the advantage of adding resources for the analyst’s self-regulation as well.     

Use of the analyst as a fetish.

In some cases a gratifying transference fantasy is the subject of progressive analytic work, while in other cases the same type of fantasy eludes investigation, and its enactment causes treatment to become an unproductive endless task. One cause for the latter difficulty can be that the patient uses his or her analyst as a fetish, permitting the distinction between reality and fantasy to remain inconclusive, so that relinquishment of magical expectations does not take place. The particular form of thinking involved in use of the analyst as a fetish is described. The role of illusion, its various clinical manifestations, the countertransference reactions they can evoke, and the technical problems posed are discussed. Special attention is given to the crucial issue of termination. By considering extreme instances in which use of the analyst as a fetish predominates, the author hopes to call attention to a phenomenon that appears to some degree in many, if not all, analyses.     

Writing about patients: IV. patients' reactions to reading about themselves

When analysands read about themselves in reports, their reactions range from anger, disappointment, or condemnation to a sense of appreciation or even idealization of the analyst. The eleven interviews reported here reflect only conscious responses; the unconscious layers were not probed for. It should be kept in mind also that the analysts of these patients might report very different stories. Other limitations are the small sample size and the representation only of patients who volunteered. Nonetheless, the information they provide may help analysts consider how and when writing about patients may influence their representation of themselves, the analyst, and analysis itself.     

Transferences in parent–infant psychoanalytic treatments

In parent–infant treatments, babies sometimes exhibit symptoms such as screaming, clinging, and fearful gaze avoidance of the analyst. The paper investigates if such phenomena may be regarded as transference manifestations, and if so, if they appear both in younger and older infants. Based on three case presentations, it is concluded that some babies are capable of forming both brief and enduring transferences. The term “indirect infant transference” refers to when a baby reacts emotionally to the analyst as long as the parent's transference remains unresolved. “Direct transference” refers to when a baby reacts in a non‐mediated way to the analyst. The necessary tool of investigation for discovering these phenomena is a psychoanalytic method with an explicit, though not exclusive, focus on the baby. Discerning them in the clinical encounter may help us understand the baby's predicament and when and how to address the baby or the parent. These treatments constitute an empirical field awaiting more extensive clinical and theoretical investigation. Already now, they suggest that transference may be rooted in, and may appear during, very early developmental stages. The paper's positions are compared with those put forward by other parent‐infant clinicians.