Enrique Pichon Rivière's conception of reality in psychoanalysis

The author places the subject of his paper in the context of the original views of a school of Argentinian psychoanalysts that differed from traditional conceptions of man and his 1 relationship with the sociocultural context – that is, with reality. These were the analysts who followed Enrique Pichon Rivière and further developed his ideas – namely, Madeleine and Willy Baranger, José Bleger, and David Liberman. The author begins his exposition with a discussion of Pichon Rivière and culture. He then offers an outline of Pichon Rivière's particular conception of man, followed by a section on the Internal Group as the nexus between the psyche and reality. Further sections address the idea of reality in the analytic situation as a dynamic field and the operative definition of the transference; the distinction between perceptual reality and the reading of reality, with a consideration of the notion of ‘critical judgement’; and lastly the issue of health and illness in terms of adaptation to reality. In addition, on the basis of a quotation from Antonio Damasio, the author draws a parallel between these psychoanalytic thinkers’ ‘psychosocial’ approach to man and the findings of contemporary neuroscience as presented by one of its paradigmatic protagonists.     

Sense of reality,reality testing and reality processing in borderline patients1

Although borderline patients are suitable for it, they often undergo repeated testing of phantasies against objective reality without success. A reason for these partial failures is that subjects have not been able to build a solid sense of reality and have found many diffi culties for processing reality demands and possibilities. The author puts forward some thoughts on this question, such as the importance of working through the depressive position and the Oedipus complex in the process of building up a solid sense of reality. A sense of reality also favours continuous reality processing. When reality processing becomes as continuous as life itself, the repetition of individual reality tests becomes less frequent and necessary, and more satisfying. The author also presents some recommendations for the psychoanalytic treatment of such patients, stressing the importance and the diffi culties of the introduction of the borderline patient into the triangular situation because primitive defences‐such as disavowal and denial‐are mobilized.     

MOURNING IN THE PSYCHOANALYTIC SITUATION AND IN SHAKESPEARE'S THE TEMPEST

Recognizing that mourning builds psychic structure, the author highlights the ubiquitous and essential nature of mourning in the psychoanalytic situation. Reality testing is intimately connected to mourning and is the warp on which psychic structure is woven in the analytic situation. Reality testing necessarily involves opportunities for mourning and thus will be present in every analytic hour. The confrontation with reality is the basis for all processes of mourning, or for creating defenses against this painful experience. The author views mourning as fundamentally a transformational process, and Shakespeare's The Tempest is used to illustrate this aspect of mourning.     

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.     

Analysts' observing-participation with theory

The author summarizes some of the literature's critiques of psychoanalytic theory, which have noted its constrictive quality and failure to take into account the vicissitudes of treatment within each analytic dyad. Such postmodern reactions have given rise to a countertheoretical trend toward psychoanalytic pluralism, leading the author to suggest that a single, standard psychoanalytic technique no longer exists. The interpersonal tradition, which tends to prioritize praxis over theory, is discussed in the light of its emphasis on an intersubjective model of participant-observation, and two clinical vignettes are presented to illustrate the author's way of utilizing this model.     

‘Characters’ in psychoanalytic and interpersonal therapy: A comparison

In this paper the author considers how the therapist might listen to the characters talked about by his or her patients. In psychoanalytic therapy the emphasis is on listening to the patient's characters as though they are located in psychic reality and as representatives of the transference relationship, whereas in interpersonal therapy (IPT) the patient's characters are taken as inhabiting the realm of external reality. It is argued that clinical thinking in IPT would be enhanced by taking more account of psychic reality, which will make clearer the quality of external reality in which the patient's characters are located. It is also argued that both therapies share an interest in enabling the patient to find characters which can serve as holograms of previously unexpressed affective experience.     

Collusive induction in perverse relating: Perverse enactments and bastions as a camouflage for death anxiety

The author argues that one of the main functions of perverse relatedness is to induce the analyst into becoming the patient's unconscious accomplice in a “perverse pact” against the analytic work aimed at disavowing intolerable aspects of reality. The intense power of collusive induction in perverse relating leads the analyst to participate in transference‐countertransference enactments and to the crystallization of a silent and chronic unconscious collusion between the patient and analyst in the analytic field, stagnating the process (bastion; Baranger and Baranger). The author claims that analysis of perverse pathology should not be limited to interpretation of the patient's intrapsychic functioning but should also focus on the information obtained by the analyst through his participation in collusive enactments; the analyst should also take a “second look” at the analytic “field” to detect underlying bastions. The author reviews the main psychoanalytic contributions that have clarified the phenomenon of collusive induction in perverse relating and as an illustration, describes the analysis of a man with a perverse character; in this patient, one of the main functions of his perverse relatedness was to induce the analyst to become an accomplice in his disavowal of his terror of death. The author highlights the influence of death anxiety in the bastions that develop in the treatment of perverse patients.     

FROM EXTENSION TO REVOLUTIONARY CHANGE IN CLINICAL PSYCHOANALYSIS: THE RADICAL INFLUENCE OF BION AND WINNICOTT

This paper addresses the radical departure of late Bion's and Winnicott's clinical ideas and practices from traditional psychoanalytic work, introducing a revolutionary change in clinical psychoanalysis. The profound significance and implications of their thinking are explored, and in particular Bion's conception of transformation in O and Winnicott's clinical‐technical revision of analytic work, with its emphasis on regression in the treatment of more disturbed patients. The author specifically connects the unknown and unknowable emotional reality‐O with unthinkable breakdown (Winnicott) and catastrophe (Bion). The author suggests that the revolutionary approach introduced by the clinical thinking of late Bion and Winnicott be termed quantum psychoanalysis. She thinks that this approach can coexist with classical psychoanalysis in the same way that classical physics coexists with quantum physics.     

Miscarriages of psychoanalytic treatment with suicidal patients2

The author describes a particularly perilous frontier on the psychoanalytic landscape‐ namely, the treatment of suicidal patients with serious personality disorders. Using a clinical example of egregious boundary violations by an analyst, he describes specific countertransference pitfalls that lead to mishandling the patients' expressions of suicidal despair. These include disidentification with the aggressor, failure of mentalization, collapse of the analytic play space, reactions to loss in the analyst's personal life, omnipotence, envy of the patient and masochistic surrender. The author emphasizes the unique vulnerabilities that accompany analytic treatment of such patients.     

Concurrent individual and individual-in-a-group psychoanalytic psychotherapy

This paper's thesis is that concurrent individual-in-a-group and individual psychoanalytic psychotherapy can be conducted in conformance with psychoanalytic principles of treatment as well as can individual psychoanalytic psychotherapy alone. American psychoanalysts have shown little interest in group psychotherapy, probably because of earlier criticism that transference is diluted by the greater reality of the therapist in group psychotherapy. This is a misconception extrapolated from the mirror model of dyadic analytic technique. The criticism was formulated during a period when that model was prominent and there was little awareness that the actual personal relationship between patient and analyst played an important facilitating role in the dyadic analytic process, including providing a basis for investiture of transference. Also, the criticism was based on one-session-per-week group psychotherapy, whereas concurrent individual-in-a-group and individual psychoanalytic psychotherapy utilizes two group sessions plus one or two individual sessions per week, enabling a more intensive patient-therapist relationship. Concurrent group and individual psychoanalytic psychotherapy constitutes a contribution to the widening scope of application of psychoanalytic treatment.     

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 newspaper reader’: On the meaning of concrete objects in a psychoanalytic treatment1

The author investigates the meaning of concrete objects in the psychoanalytic treatment of a severely disturbed patient for the development of his inner world and the analytic process. She includes a survey of relevant theoretical concepts with an emphasis on Winnicott and Bion. It is shown that the objects served basic defensive functions both within the analytic relationship and for the precarious intrapsychic state of the patient. The author describes the technical dealing that led to a structural change. From the comparison of the initial dream and a later dream, Mr N's inner development from total inclusion in the object to triadic reality of separated, repaired objects becomes discernible. The author shows how this progress was facilitated by his use of concrete objects as links between his psychotic and non‐psychotic parts, as well as by the specifi c way the analyst handled the paradoxical transference‐ countertransference. She also illustrates the thesis that the developmental steps described are crucial for the capability to digest psychic pain by symbolization instead of discharging it in a destructive‐violent way.     

Some hazards to neutrality in the psychoanalysis of candidates

The author looks at the challenges confronting psychoanalysts as they attempt to approach a desirable goal of neutrality in the treatment of psychoanalytic candidates and others who will become or are professional colleagues. Many such hazards are embedded in the interlocking relationships that inevitably exist between the analytic institute and its personnel, its training analysts, and its candidate-analysands. The author considers difficulties in the crucial analysis of aggression in training analyses. The analysis of aggression plays a determinative role in the personal and professional lives of analysands, and vitally affects the health and creativity of analytic institutions and the future of psychoanalysis.     

Über das Spannungsverhältnis von Psychoanalyse und Berufspolitik

Taking the inherently conflicting relationship between psychoanalysis as a science of the unconscious and reality as her starting point the author describes the historically developed need of an extensive political commitment as a genuine task of the psychoanalyst to ensure the own group’s survival within health system in the long run. The author illustrates her argument by the numerous changes, which have been introduced into the field of professional and social law within in the last 12 years and affected clinical practice within the legal health insurance system as well as psychoanalytic training. She describes the area of tension in which politically committed psychoanalysts find themselves. These tensions are produced by a frequently met defence fuelled by anxieties and denial of the own colleagues against professional politics within psychoanalytic organisations and by various defences in extraanalytical professional politics. The author discusses ways of an individual, intrapsychical mastering both on part of colleagues committed to professional politics and of members of analytic organisations and describes ways of institutional dealing with these conflicts in psychoanalytic organisations and in the extraanalytical field of professional politics as a precondition of a more successful representation of the own group’s political interests. Finally she considers structural changes which are necessary if psychoanalysis is to succeed not only in the struggle about distribution of resources but also in the interdisciplinary scientific debate.     

Comments on the Ikonen and Rechardt papers on the death drive and the origin of shame

In this paper, psychoanalysis is viewed as a method in opposition to the reigning spirit of our age with its demands for fast and measurable results. The concept ?the psychoanalytic room” is introduced in order to grasp the uniqueness of psychoanalysis and how it distinguishes itself from what is ordinarily held to be included under the category of work. The psychoanalytic room is explored in both a concrete and metaphoric sense and is discussed in relation to the concept of time, reality, Ogden's concept of the analytic third, and, inspired by Winnicott, children's play. The playroom of the child and its similarity with the analytic room is illustrated by the book ?Benny's Bathtub” by the Danish author Flemming Kvist Møller.     

On psychic reality and neutrality: Empathy and the work of construction in countertransference

Abstract

The clinical challenges faced in encountering patients who do not fit the standard treatment of Oedipus conflicts clearly show the limitations of the interpretative method, thus making indispensable the study of clinical concepts and techniques as a way to broaden the psychoanalytic horizons. In order to analyse the different psychopathological problems resistant to traditional clinical approaches, it is necessary to reorganise the technique on the basis of a better understanding of the ways in which subjectivity is rooted in early psychic constitution. In this way, empathy becomes important as a clinical tool. The use of empathy must be understood as a decisive factor in handling clinical cases and situations in which the treatment encounters obstacles that restrict the power of the analyst's verbal interventions.In this case, can we say that the use of empathy interferes directly with and changes the position of the concept of psychic reality? Moreover, as we use empathy, can we also say that the concept of neutrality is transformed, without being abandoned? The intention of this paper is to discuss these questions using clinical material taken from the analysis of borderline clinical cases and situations.     

Selecting a patient or initiating a psychoanalytic process?

The defences provoked in the analyst by the anxieties associated with the difficult tasks of ‘assessment’ and ‘selection’ for psychoanalysis can result in a tendency to think in terms of ‘hurdles to be cleared’ by potential psychoanalytic patients, rather than ‘opening the gates’. This can result in a diminution of the analyst's capacity to enlist and sustain a psychoanalytic stance. Only within a psychoanalytic frame can a meaningful psychoanalytic process unfold, at all stages of a potential patient's movement from their first contact through to, possibly, entering into an analysis. The author illustrates the value of this thinking by describing the work of the London Clinic of Psychoanalysis where there has been a shift of emphasis in psychoanalytic consultation towards working with individuals on their potential to initiate a psychoanalytic process, and away from the sole aim of ‘selection of a suitable patient’. In this paper, the author notes that when institutional culture and practice supports psychoanalytic identity, this makes it more possible to recognize and articulate the anxieties provoked by the ‘emotional storm’ inevitable in psychoanalytic consultation, and the draw towards unhelpful enactment that may otherwise obscure the initiation of a psychoanalytic process that may or may not result in analytic treatment. Illustrative case material from the Clinic is presented.