"Working through" and the novel

Prone to jargon, psychoanalytic literary criticism must be circumspect lest it appear narrow, sectarian, judgmental or exploit a particular psychoanalytic theory. Salient imagery, symbolism, metaphor, and psychologically intuitive characterization in the novel may be viewed as evocative of central, conflictual, predominantly unconscious source of experience or fantasy (Arlow, 1979) synchronizing with autobiographical and biographical data in achieving more dynamic, interpretive syntheses. VW's emotional state is an emergent of her total personality interacting with and evolving in her highly complex family milieu. Though she claimed writing the novel modulated the preoccupation with her parents, essentially VW did not resolve her obsession with the cumulative and untimely deaths of her parents and siblings but engaged in her writing in a perpetual mourning of these and other psychological losses for most of her life. Her life and work reflect the processes of "repetition" and "elaboration" also intrinsic to the psychoanalytic process but she did not achieve the memory "reconstructions" and "changes in self-esteem" alluded to by Kris (1956a, 1956b) and Greenson (1965) as intrinsic to the psychoanalytic experience of insight and "working through."     

Early object loss and denial. Developmental considerations.

The psychoanalytic treatment of a young woman whose father had been killed in a concentration camp when she was four years old serves to illuminate certain aspects of libidinal and ego development, particularly as it touched on the effects of losing one's father just before entering the oedipal phase and on the defensive use of denial in lieu of mourning. Further consequences of the patient's loss are seen in the extent to which it influenced the self-image, sexual identity formation, and superego functioning, especially with regard to the role of guilt.     

Long-Term Psychoanalytic Therapy as a Life-Saving Procedure

A dramatic long-term psychoanalytic treatment of a psychotic character disorder is presented in detail. This patient began therapy with a long standing history of an eating disorder for which she had received many hospitalizations and forms of treatment without any success. She was in a deep despair and as a last resort agreed to a psychoanalytic therapy. During the many years of treatment the eating disorder completely resolved but was replaced by a series of very dangerous accidents that occurred each time she was betrayed and disappointed by a boy friend. This went on pari passu with a deepening understanding of her childhood and her psychodynamics but the middle of the therapy was very stormy and required tenacious efforts to maintain the treatment. The self-destructive behavior was traced to early and profound childhood disappointments and a sense that these were her fault because she was so unlovable and therefore deserved punishment. A dangerous stalemate developed in the treatment after a number of years. The analyst presented the case to colleagues several times and wrote it up in detail, which enabled him to understand his own countertransference and resolve it. This resulted in a dramatic change in the patient and a very favorable and happy ending to this very difficult treatment after 15 years. Although the author believes all patients in psychoanalysis should be approached with as neutral and objective a stance as possible, emphasizing free association and dream material in order to interpret the crucial childhood determinants of the patient's psychopathology, in cases such as psychotic character disorders the outcome clearly also depends on interpersonal factors. The case illustrates the deep partly conscious and partly unconscious interaction between a patient and her analyst over many years of treatment and the profound effect this has on the outcome. It underscores the importance of patients being allowed to heal in their own way and in their own time without intrusion or interference from the analyst. It also demonstrates the crucial importance of long-term psychoanalytic therapy as a life-saving procedure in cases where it is appropriate in spite of the great amount of time and expense involved.     

Freud, Dora, and the maid: a study of countertransference

Early advances in psychoanalytic knowledge, profound though they were, were incomplete structures to be built upon, modified, and partially discarded. In addition to errors due to insufficient knowledge, Freud's difficulties with Dora stemmed from countertransference. Dora's transference included an identification with a governess/maid. Important oedipal role played by a nursemaid in Freud's life made him vulnerable to being left by Dora. The maid, Monika, "the prime originator" of Freud's neurosis, seduced him, chastised him, and taught him of hell. In his self-analysis she was associated with Freud's mother who left him when she gave birth to his sister. When he was two and a half years old, Monika was discharged and jailed for stealing. I suggest that Freud's attraction to Dora revealed itself in his libidinal imagery of the treatment and his premature sexual interpretations, the effects of which he misjudged. Defending against his attraction, he pushed her away from him, did not act to keep her in analysis or allow her to reenter analysis later. In addition, since Dora had left him as he must have felt his childhood nursemaid had, he reacted as if she were that maid. Hurt, saddened, and angered, he used reversal and deserted her, thus damping his feelings.     

Object loss, renewed mourning, and psychic change in Jane Austen's Persuasion

Austen's extraordinary realism in depicting the dynamic internal processes which follow on the heroine's loss in Persuasion becomes clear in the light of a psychoanalytic understanding of mourning. Persuasion dramatizes the effects of a mother's death in adolescence as these come into play at the time of the heroine's separation from her fiancée and her later mourning. The thesis of this paper is that, despite falling in love with the brilliant hero, an unfinished mourning and an unconscious identification with her dead mother helped to persuade the heroine Anne Elliot to break her engagement, to create a 'final parting' as her mother had done to her in dying. The heroine's internal monologues show that she has projected some of the darker feelings of mourning, her anger and resentment, on to the hero and that she reopens a complex mourning process, partly through the displacement of affect, showing how traumatic effects of loss can be worked through in deferred action, effecting positive psychic change.     

A Single Intervention: A Visit to the Family

The following letter is reported unchanged except for disguised names. Concern with repairing disrupted relationships of adult members of a family with their own parents has been a matter of growing interest to a number of family therapists; Bowen (1), Boszormenyi-Nagy (2), and Framo (3), among others have stressed the importance of sending family members back to their families of origin. This report makes no effort to formulate the process in any particular theoretical framework (i.e., as reestablishing connectedness after an “emotional cut-off” or rebalancing a ledger of fairness, or whatever) but is intended only to illustrate the kind of outcome one may hope for in prescribing such a maneuver. It is offered simply as a clinical note. The letter needs little prefatory explication. Mr. Jack Newburgher had been a patient in psychoanalytic treatment for four years, with a quite successful outcome. On two occasions in the course of his therapy a joint session had been held with Mr. Newburgher and his wife, Muriel, when changes in his behavior had precipitated crises in the marital relationship. His therapy had terminated about two years before the visit referred to in the letter. Mr. Newburgher had called and asked for a joint consultation with Muriel about an acute family problem they were experiencing. Some — not all — of the background material was described, not nearly as coherently as it is reported in Muriel's letter, but in sufficient detail to make it plain that she was in distress about having to withdraw completely from her parents and that their family was in disarray as a consequence of her distress. The acuteness of the emotional disturbance, against a background of a lifelong adversary relationship between Muriel and her father and a history of ten years of illness on her fathers' part, suggested that the distress was the product of Muriel's anxiety and guilt over a decision to cut herself off completely from her parents. As a consequence, Muriel was urged to visit her family of origin, with the caveat that she might indeed discover them to be malignantly self-centered people indifferent to their effect on her and her family, but that she would at least have the gratification of having tried. The reference to “speaking French” was to the therapist having suggested that, on the other hand, she might find that her parents expressed their feelings in a different modality from her definitions of how feelings should be expressed, much as though their native tongue were French and she were insisting that they must speak to her in English.     

Words Just Don't Cut It: Commentary on Paper by Mary E. Sonntag

In this discussion, I highlight the use of bodies in the place of worded language in Sonntag's clinical work with her patient Olivia. Loewald (1980) described the embodied aspects of primary process making the words of secondary process meaningful. As a survivor of sexual abuse and numerous medical invasions, Olivia does not have the capacity to meld primary and secondary process to create symbolization. Instead, she struggles to create meaning through a multiplicity of dissociated bodies and self-destructive behaviors. I describe the function of these dissociated bodies, in particular that of her puppy, and the imperative role Sonntag plays when she listens and communicates through Olivia's embodied language instead of interpreting through psychoanalytic words.     

The role of the analyst in the analytic cure during times of chronic crises

The role of the analyst in psychoanalytic treatment during periods of chronic crises is illustrated with material from two case studies. The first clinical vignette shows an analyst able to stay with fears evoked in the patient by the traumatic external reality, even as the analyst tried to explore with the patient an inner universe that handled this reality in unique ways. The second case study focuses on how the analyst's countertransference during this period of chronic crises, which she was experiencing along with the patient, made it difficult for her to contain the patient's fears and anxieties, because of the threat to her own existence, as well as to her identity as an analyst. In this second case the analyst, out of denial of the external situation, focused blindly on the patient's internal reality in order to counteract her own sense of passivity and helplessness in the confrontation with death and destruction. She clung to "classical" analysis by trying to analyze the patient's defenses, work them through, etc., thus making so-called analytic interpretations rather than staying with the patient's fear, as well as her own, and helping the patient more directly. A turning point came with the birth of the analyst's granddaughter; fear for the new arrival's safety made the analyst sharply aware that it is impossible to ignore external reality, that it must be given a place both in everyday life and in analysis. This awareness enabled the analyst to contain the patients' fears, which helped him feel more supported and facilitated change.     

A Comparative Assessment of an Analysis of Envy: Commentary on Paper by Julie Gerhardt

This discussion is introduced with emphasis on the need for comparative psychoanalytic studies in our pluralistic psychoanalytic world and describes an approach to such an endeavor. A very brief comment on the extensive literature review is followed by a more detailed focus on the “analysis of envy,” which gradually changed into the analysis of the patient, as a person. The discussant's “empathic entry” into the analyst's mode of listening and responding was simultaneously also applied to the patient's experience, to see how well patient and analyst communicated with each other and whether or not the patient indicated that she felt understood or not. When she did not feel understood, the patient signaled this with an intensification of her envy into furious “envy attacks.” The analyst's “decoding interpretations” implied that the patient was causing her own problems and should not feel the way she did. The analyst discovered this later herself. Her discoveries in the fourth year of the analysis yielded notable changes both in her approach and in the patient's progress. Ultimately, the analyst allowed her subjectivity to enter the analysis and became better amalgamated with her chosen theory, leading to the changes in a progressively more fruitful analysis.     

How to grow up or (nearly) die trying: developing trust in one’s own capacity for growth

This paper is a single case study describing intensive psychoanalytic psychotherapy with an adolescent girl, an apparently bright and capable girl who was struck down at 15 by a double blow of trauma and loss. She cracked along her fault lines which, it is argued, were created during the ordeal of her psychic birth in the first year of life. It is proposed that ordinary Oedipal humiliations precipitated anxiety about dependency. While any adolescent is likely to have to grapple with these difficulties, the terrible life events that befell this girl compounded her dependency just when she might have been moving towards independence. In addition, the ordinary task of mourning childhood and familiar family relationships was obscured by the new and devastating losses that needed to be mourned. Unable to face this task, she spurned the support of her loving family and any potential good object and instead became dependent on manic over-achievement and grievance. The paper traces how the intricacies of the patient’s internal world slowly unfurled through the transference and countertransference and through her story as she told it to her therapist. The therapist describes the slow and difficult process of making links between that story and their experiences together in the consulting room. The theoretical concepts that enabled these links to be made are outlined and the ways in which they guided the therapist’s technique are discussed.     

Marco Conci interviews Stefano Bolognini

Abstract

This paper suggests that the understanding of intersubjectivity, which refers to “the dynamic interplay between the analyst's and the patient's subjective experiences in the clinical situation”, is crucial for psychoanalytic work. The analyst's inner experiences, from the first moment that he or she thinks about or meets the patient, belong to an intersubjective situation. Not only are these experiences a valuable channel through which the inner experiences of the patient can be understood, but—as Theodore Jacobs puts it—they are often complementary to that which comes from the patient. The author tries to illustrate the above through the study of the analytic process in the psychoanalytic therapy of a severely disturbed patient. This therapy from its very early phase led to the reawakening of some of the analyst's old conflicts. The patient's difficulties in tolerating the limits of the analytic setting and using free association are discussed, as are his enactments. The analyst's close observation of the interaction between her and the patient, the permanent engagement with her countertransference, and the use of her inner experiences with the patient helped her to contain the enactments, defined the nature of her interventions, and contributed to the analytic process.     

Identifications Annealed,Adhesive and Political: Commentary on Paper by Nina Farhi

Farhi's fascinating paper pays tribute to and extends those segments of Milner's clinical work that Milner hesitated to theorize explicitly herself. Seeking to understand the latter, I trace psychoanalytic politics in general and the history of Milner's relationships with Winnicott, Klein, and Riviere in particular to explore how her dutiful compliance to the rigid taxonomy of psychoanalytic power of her time bore on the trajectory of her becoming an analyst with a mind of her own. It is in accounting for how she struggled to disentangle herself from that web, that we discover how Milner was able to creatively refashion her work with her patient Susan, a process by which Susan was greatly impacted.

Following the trail of Farhi's ideas around this process and considering her thoughts around their psychic meanings for both analyst and patient, I explore their clinical implications. I focus on the transferential iterations of these dynamics to consider Farhi's suggestion that an annealed bond needs to be established in the treatment of patients who have, early in life, failed to develop annealed identifications. This opens up questions around how such bonds can malignantly colonize the analyst's mind and psychic reality, raises questions of self-care in the analyst and contributes to prognostically anticipating certain sets of enactments in the course of long-term psychoanalyses.     

Reflections on the setting in the treatment of adolescents1

The author focuses on the signifi cance of the setting for the development of the psychoanalytic process, especially in the case of adolescents who request analytic treatment. Her main goals are to specify: a) how the setting is confi gured with this type of patients; and b) to what extent it contributes to the creation of an inner space that may internalize a fi gure with reverie‐a good object that will metabolize the bad and thus enable identifi cation. The setting, which is considered the necessary context for analytic work, is defi ned as bearing two facets: that of the analyst, which must be constant and stable, and that of the adolescent, which will progressively change provided that the analyst maintains a fi rm context that contributes to make the adolescent feel contained and accepted. It is such a feeling that will enable the unfolding of the analytic process. The author emphasizes the importance of the presence of the analyst (his or her voice, the manner of his or her speech, and so on), and the need for the analyst to comply with the rules he or she has established together with the patient. She presents a clinical case to illustrate this conceptualization.     

Demeter's Compromise: Separation,Loss, and Reconnection in Mothers with Daughters Entering Adulthood

Drawing on contemporary theory of female development that focuses on the dynamics of the mother/daughter relationship regarding issues of separation and individuation, this article examines the treatment of a middle aged mother as she navigates her way through her daughter's adolescence and early adulthood. Psychoanalytic object relations, psychoanalytic relational theory, and feminist theory serve to frame an understanding of the case material in terms of developmental challenges that are uniquely female. Issues around mother/daughter attachment, separation, competition, conflict, and love are explored in the relationships between the patient and her mother, the patient and her daughter, and the patient and the therapist. The therapist's countertransference, intensified by her relationships with her own mother and daughter, suggests the possibility of both pitfalls and opportunities in the treatment. The article attempts to address a gap in psychoanalytic developmental theory, which offers little understanding of the challenges for women in midlife.     

Mutilation of self and object: the destructive world of the paranoid-schizoid patient and the struggle for containment and integration

Using case material, I have described the three overlapping phases of treatment that occur with some borderline, narcissistic, or psychotic patients. These patients are dealing with paranoid-schizoid experiences of the self and the object. In this part-self, part-object world, many shifting, opposing, and contrary states of feeling and thought occur. Acting out is the first phase of analytic treatment. This is an externalization of persecutory anxiety, primitive guilt, and phantasies of annihilation. Projective identification, splitting, and denial are common and tend to make for difficult transference and countertransference problems. During the middle phase of treatment, pathological superego states and manifestations of death instinct color the analysis. The death instinct reacts defensively to the sadistic superego. Technically, the destructive internal conflicts created by these two elements must be clarified and interpreted in the transference. Flexible analytic management and containment are crucial supplements to ongoing interpretation. If these chaotic patients are able to stay in treatment for a period time, the acting out and the superego/death instinct phase gradually give way to phantasies of loss. This is still a paranoid-schinoid perspective of loss, making it persecutory experience. Although depressive anxieties do enter the picture, these still involve pathological anddestructive states of guilt and all-or-nothing threats of abandonment and attack. A case was presented in which the patient managed to continue into the third stage of analytic treatment, long enough to benefit frominternal, structure change. In this final stage, the patient "O" was able to acknowledge, work through, and integrate her prior feelings and phantasies of loss, persecution, and abandonment anxiety into more manageable and reality-based depressive functioning.     

On lying and the lie of a toddler

For most of its history, the psychoanalytic literature on lying dealt exclusively with the dynamic, genetic meanings of lying: the problems for treatment presented by a patient who lies, and the technique used in dealing analytically with lies. In recent decades, issues relating to the moral and general development of children in relation to lying have been considered. In this paper, a lie told by a 21-month-old child is used to raise and explore questions about lying and its relation to intrapsychic structure and development. It is suggested that cognitive abilities and the psychic apparatus have to develop to the point that self can be distinguished from object, and a superego prototype must be present, before the means and motivations for lying are in place. This would date the beginning of the capacity to lie to sixteen to twenty-four months of age.     

CHARACTER,PSYCHOANALYTIC IDENTIFICATION,AND NUMERICAL IDENTITY

Identification figures prominently in moral psychological explanations. I argue that in identification the subject has an ‘identity‐thought’, which is a thought about her numerical identity with the figure she identifies with. In Freud's psychoanalytic psychology character is founded on unconscious identification with parental figures. Moral philosophers have drawn on psychoanalysis to explain how undesirable or disadvantageous character dispositions are resistant to insight through being unconscious. According to Richard Wollheim's analysis of Freud's theory, identification is the subject's disposition to imagine, unconsciously, her bodily merging with the figure she identifies with. I argue that this explanation of identification is not adequate. Human character is held to be capable of change when self‐reflection brings unconscious identifications to conscious self‐knowledge. I argue that for self‐knowledge these identifications must be an intelligible part of the subject's self‐conception, and that Wollheim's ‘merging phantasy’ is not intelligible to the subject in this way. By contrast, the subject's thought that she is numerically identical to the figure she identifies with does provide an intelligible starting‐point for reflecting on this identification. This psychoanalytic account provides a clear conception of identification with which to investigate puzzle cases in the moral psychology of character.     

Sibling rivalry,separation, and change in Austen's Sense and Sensibility

The paper explores a process of growth represented in the interplay of Jane Austen's characterizations of Marianne and Elinor Dashwood in Sense and Sensibility, approaching the text through the lens of psychoanalytic theories on oedipal sibling rivalry, separation, and processes of change. A close reading of Sense and Sensibility tracks Marianne Dashwood's repudiation of any ‘second attachment’ as the surface of an unconscious fantasy, denying a rival for the mother's love. A psychoanalytic view contrasts Marianne's lack of separation from her mother, her use of denial and projection, and her near death after losing the man she loves, with her older sister Elinor Dashwood's capacities for depression, reflection, and greater acceptance of loss and separation. The narrative portrays Mrs. Dashwood's identification with and idealization of her daughter Marianne, which contribute to her oedipal sibling ‘victory’. In the language and structure of the novel, the projections, identifications, aggressions, and separations (conscious and unconscious) of the sisters in the vicissitudes of their adolescent loves and rivalries constitute a process of growth. Austen's novel brings to life, with the vividness and coherence of great literature, forces and fantasies in oedipal sibling rivalries, inspiring renewed attention to their subtle presence in the transference and countertransference of the psychoanalytic process.     

Why not give your client a counter: A survey of what happened when we did

A perusal of the recent literature of behavior modification shows an increasing emphasis on the use of self-recording as a research tool (see for example, Barlow et al., 1969; Duncan, 1969; McFall, 1970; Johnson and White, 1971 ; and Ackerman, 1972). In addition, self-recording is being more frequently utilized as a method of teaching students, clients and patients to (a) observe themselves more precisely, (b) assess the effects of treatments which they apply to themselves, with or without the guidance of a counsellor or therapist, and finally (c) provide the latter with objective information (see for example, Stuart. 1967; Lindsley, 1969; Kanfer, 1970; Duncan, 1971; Watson and Tharp, 1972; Mahoney and Thoresen, 1974; Thoresen and Mahoney, 1974; Zimmerman, 1975).

Several researchers have suggested and provided evidence for the notion that self-recording of one's own behavior can be a reactive measure which leads to behavior change on the part of the recorder without the addition of further treatment (see for example, McFall, 1970; Johnson and White, 1971; McFall and Hammen, 1971; Kazdin, 1974; and Lipinski and Nelson, 1974). Preliminary results which each of the present authors have observed with some self-recording clients confirms the above observation. Furthermore, we have also observed that self-recording can sometimes lead to unexpected, therapeutic side-effects. For example, the junior author recently gave a golf counter to a 17-year-old female patient who reported having many impulses to “go back and check” things before leaving her home. These impulses were usually acted upon and one of the consequences of this was that the patient usually kept her parents waiting when the three had to go out. This patient was asked to wear a golf counter, which was given to her, to count the number of times each day that she had an “impulse to check”. In an interview with her following a 7-day counting period, she reported that she had not been aware that she had so many impulses (103 the first day of counting); she actually felt revulsion with herself upon clearly seeing how frequently she had these impulses; she had more impulses when nervous and fewer when relaxed; and finally, both the number of impulses and the actual number of times she acted upon them were markedly reduced over the 7-day counting period. This set of results, together with other (albeit less dramatic) results, suggested to us that some clients can benefit merely by self-recording their own behavior. For some the benefit may be greater awareness or knowledge of the self-recorded behavior, for some it could be actual behavior change, and for some both benefits might be achieved.

To our knowledge, no study has been conducted which has surveyed such possible benefits of self-recording across a number of clients and under conditions in which many therapists are involved. The purpose of the present study was to explore the effects of self-recording, per se, across many clients who were being seen by many different therapists. We did so by recruiting therapists who would be interested in trying out the procedure of having one or more clients self-record.     

Mutative interpretation and close process monitoring in a study of psychoanalytic process

When James Strachey defined the mutative interpretation, he did not have defense interpretation in mind, but a few years later Anna Freud opened the door to new ways of making small-scale non-transference and transference interpretations that alter superego functions. Using her model and a special mode of listening, the authors suggest an updated technique of intervention with resultant superego change, which qualifies for consideration as a later version of the mutative interpretation.