Judicious Self-Disclosure by the Psychoanalyst

One of Sándor Ferenczi's greatest contributions to clinical theory and method is his pioneering concept of analyst self-disclosure. First introduced in his famous paper ?The elasticity of psycho-analytic technique? (1928), analyst self-disclosure changed the nature of clinical interaction between analyst and analysand, from the Freudian model of a surgeon to the responsiveness of an empathic mother. Ferenczi's clinical work with the so-called ?difficult cases? (narcissistic, borderline and psychotic disorders) moved him to discover the ethos of activity within an empathic method. Analyst self-disclosure is one of those responsive measures he developed to address the deficits in communication and interpersonal functioning in trauma survivors. An outline is presented of the ?Confusion of Tongues? which is the model from which self-disclosure is derived. A contemporary extension of this idea is offered in the clinical and theoretical distinction between judicious vs. conspicuous self-disclosure.     

The Integrity of the Psychoanalyst

Against the background of psychotherapeutic work with a young self-harming woman, a theoretical argument concerning the body is developed. The body of the drives and of infantile sexuality is distinguished from the body of instinct and attachment. The origin of the drive is discussed in terms of Laplanche’s fundamental anthropological situation and linked to Jacques André’s thesis concerning a primary femininity and drive passivity in both sexes. Freud’s thinking on sexual difference and the repudiation of femininity is discussed from the perspective of the above-mentioned thinkers. Finally, a sexual perversion, acted out by the patient, is explored as a possible symptomatic/conflictual expression of drive passivity.     

Carl E. Schneider,The Practice of Autonomy: Patients,Doctors, and Medical Decisions

Theoretical Medicine and Bioethics -     

The Theory and Practice of Psychiatry by Frederick C. Redlich and Daniel X. Freedman

Abstract

The noted humorist Dave Barry, in looking back over his life and thinking of things he had learned, said one of the things he learned was that “There is a very fine line between ‘hobby’ and ‘mental illness’” (1998, p. 182).

Following in Dave Barry’s path, I would like to look back over the 45+ years I’ve been practicing group therapy and see if there is anything to be learned by what I have learned over those years.     

Reply to Commentary by Daniel N. Stern

I respond to Stern's largely affirming discussion by fleshing out a few points, for example, improvisation is more than just being spontaneous, it is ensemble work that plays off and with patterns emergent in the personalities of both parties. These patterns illuminate something about the unconscious of each from which blossom things heretofore unimagined or unarticulated. Several principles are then emphasized: First, improvisational moments arise when the “characters” in the moment draw from something real within themselves along with who they are inducing one another to become. Second, the cultivation of play in improvisation lends itself to putting to rest the myth of the perfectly analyzed analyst as not only impossible but as being both unnecessary and undesirable—a seminal point to the entire relational canon. Third, improvisation is a means for putting live flesh on the sterile bones of a host of theories now informing the contemporary psychoanalytic perspective such as chaos and complexity theory, along with dynamic systems theory. I also note that improvisational moments exhibit an emerging sense of vitality and a deepened sense of connection between the partners. Their work obtains a greater sense of focus, though not a deliberate focus as that their relational unconsciouses are “directing” them. Improvisational work feels liberating, playful, as well as affirming and recognizing what what each is bringing to their coauthorship. By contrast, when the improvisation fails, it devolves into negative thirdness or one-upsmanship, the qualities of which reflect deadness, avoidance, confusion, constriction of play, and a misrecognition of one another that devolves into a mutual sense of defeat. Responding to Stern's question about posi-traums, I affirm there is a phenomenon in which an entrenched emotional conviction of a patient's can be dramatically altered. This happens when something positive occurs that cannot be assimilated within the patient's intransigently negative belief system such that she must accommodate a new organizing principle, that is, a new emotional conviction to make sense of it. I concede, however, that it may be too soon to tell how much such phenomena penetrate the more physiologically encoded elements of trauma.     

Motor intentionality and the case of Schneider

I argue that Merleau-Ponty’s use of the case of Schneider in his arguments for the existence of non-conconceptual and non-representational motor intentionality contains a problematic methodological ambiguity. Motor intentionality is both to be revealed by its perspicuous preservation and by its contrastive impairment in one and the same case. To resolve the resulting contradiction I suggest we emphasize the second of Merleau-Ponty’s two lines of argument. I argue that this interpretation is the one in best accordance both with Merleau-Ponty’s general methodology and with the empirical case of Schneider as it was described by Gelb and Goldstein.

The Scientist and the Artist: adaptive dissociation within the HIV-positive population

This paper reports on the findings of two independent qualitative studies which were conducted with HIV-positive cohort over a period of 2010–2012. Although the original studies used different qualitative designs (IPA and Grounded Theory), the authors have nevertheless sought to explore the combined utility of their findings by using a broad stance of phenomenological enquiry. The authors argue that evidence of a particular dissociative pattern in their accounts of an HIV-related experience is present in the contributors' narrative. Dissociation in this context occurred not in personality but between different or discrete mental faculties such as memory, emotions, perceptions and thought. It was suggested that it serves adaptive function and therefore could be utilised in clinical work when appropriate.