Joseph and His Brothers: A Biblical Paradigm for the Optimal Handling of Traumatic Stress

The long-lasting effects of emotional trauma and the important role of unconscious emotional defenses have become increasingly recognized only in the past century. Yet their role is actually manifest, although still overlooked, in one of the most well-known of biblical stories. This paper presents the story of Joseph and his brothers, and the important lessons it teaches about unconscious defenses and the optimal handling of emotional trauma.     

Opening the closed heart: affect-focused clinical work with the victims of early trauma

This paper begins with the understanding that early trauma leads to powerful dissociative defenses which injure the capacity to feel. It further explores ways to restore this capacity through body-centred attention to affect-in-the-moment in the psychoanalytic situation. Using the author’s personal experience while in analysis as well as a case of severe early trauma, he demonstrates the consciousness-killing effect of primitive defenses and shows how body-sensitive techniques hold the promise of restoring the patient’s sense of aliveness and hence, opening the unconscious to those affect-images that are the building blocks of the human imagination. A final section focuses on the neglect of feeling in Jungian psychology and suggests that the “creation of consciousness” which Jung described as his personal myth, is quintessentially a process of emotional transformation – of bringing unconscious suffering into consciousness – as feelings.     

Psychoanalytic perspectives on music: an intersection on the oral and aural road

This paper is organized around two ideas. The first invites the reader to consider the importance of music in emotional life, suggesting that for some people, music can have profound, deep, and transformative effects, both in loosening defenses and in deepening the psychoanalytic experience. The second idea is that analysis of the formal properties of music have both specific and overdetermined meanings that share elements with psychoanalytic principles. I suggest that, if the verbal analysis of dreams paves a royal road to the unconscious, the formal properties of music provide an aural road to the same destination. Two clinical vignettes and scenes from Verdi's opera Otello are used to illustrate these interrelated ideas.     

Why Don't People Change? A Psychoanalytic Perspective

From a psychoanalytic perspective, a central reason that people do not easily change is their fear of the dangers that they believe, at some level, change entails. These dangers include relinquishment of infantile wishes and fantasies, anxiety that would be experienced were defenses weakened, guilt, fantasies that change would harm a parental figure or threaten a vital relationship. Other factors that prevent change and maintain the sameness of behavior include defenses, unconscious pathogenic beliefs, devotion and loyalty to early figures, stable internal working models of self, other, and prototypic interactions, and emitting cues that elicit responses from others that confirm these working models. Finally, 1 discuss some selective psychoanalytic research on therapeutic change.     

Knowing What To Do,When, and How: An Integrative Approach to the Use of Psychoanalytic Play Therapy with Children Affected by Cancer

This article delineates a comprehensive approach to play therapy in work with children with cancer. It considers different psychological needs experienced by the patient in connection with significant moments related to cancer treatment and the psychological tasks it involves. Different therapeutic aims are presented, and the therapeutic components related to each are described in detail. The therapeutic aims approached by play therapy are reality testing and ego strengthening, unveiling and working through of unconscious conflicts related to disease, and defense maturation. Therapeutic components leading to the attainment of those aims include the provision of realistic information about diagnosis and treatment by means of play, the use of play as a space for containment, the detection and interpretation of unconscious anxieties and defenses within play, and the exploration and trial of adaptive defenses in the face of illness-related anxiety. Implications of this approach in terms of the precision and flexibility of therapeutic actions and the diversity of roles played by the therapist are discussed.     

Defense mechanisms in psychology today. Further processes for adaptation

Although the concept of the defense mechanism was rejected from academic psychology for a number of years, recent empirical studies show renewed interest in defenses. Cognitive psychologists have confirmed the existence of unconscious psychological processes, a requisite for defenses. Developmental, personality, and social psychologists have all found evidence for defense mechanisms that explicate psychological functioning. The relevance of this new information for clinical practice is discussed.     

Psychoanalytic observations on the effect of lithium on manic attacks

This paper describes a predictable relation between our manic-depressive patients' blood lithium levels and particular changes in their conscious and unconscious mental processes (i.e., their thoughts, wishes, fantasies, inclinations, and feelings). These changes were, in turn, predictively related to specific changes in these patients' overt manic symptomatology. Because each of our patients' manic episodes was heralded by a marked increase in unconscious or conscious phallic sexual thoughts, feelings, and behaviors, and because this increase preceded any observed deterioration in ego or superego functioning, we hypothesize that a primary increase in our patients' phallic instinctual drives secondarily overwhelmed the capacity of their egos to defend against these drives, and that this, in turn, resulted in the development of our patients' overt manic symptoms. Psychoanalysis (or psychoanalytically oriented psychotherapy) made our patients consciously aware both of their previously unconscious phallic sexual thoughts and impulses, and of their defenses against them. This new awareness enabled our patients to recognize when their, now conscious, phallic sexual impulses and thoughts became inappropriately intensified; and this, in turn, permitted them to avoid overt manic episodes by counteracting these inappropriate inclinations with increased doses of lithium.     

Patients' theories of pathogenesis

Certain patients embark upon analytic treatment with well thought out theories regarding the origins of their difficulties. Although there is always some validity to such theories, they turn out to be incomplete and serve to screen painful recollections and pathogenic unconscious wishes and the defenses against them. Two cases are presented to illustrate how analysands use these theories in the service of resistance. Painstaking analytic work is required to elucidate their defensive nature. The narcissistic importance of such theories in maintaining a coherent narrative about one's life in the face of uncertainty is discussed, and technical and countertransference considerations are explored.     

Defenses, Personality Structure, and Development: Integrating Psychodynamic Theory Into a Typological Approach to Personality

Psychodynamic theory does not conceptualize motivated unconscious defenses primarily in terms of individual traits. Rather, a person's mechanisms of defense are understood in terms of his or her personality structure and level of psychological development. This paper outlines the way in which this perspective has been integrated into a configural approach to personality assessment. The six-group typology based on the Weinberger Adjustment Inventory (WAI) identifies higher-order personality organization through the intersection of self-reported high/low distress and high/moderate/low self-restraint. The framework incorporates a developmental perspective by assessing affect regulation in conjunction with the internalization of self-regulatory controls. The primary defenses of prototypic members of each of the six groups are highlighted, and hypothesized links to personality traits, stages of ego development, attachment styles, and proneness to specific personality disorders are discussed.     

精神分析主要概念的经验实证状况

100多年来,精神分析理论所阐述的观念已渗透到心理学、文学、艺术和文化等广泛领域。尽管精神分析享有广泛声誉,但直到最近,它才得到经验实证的支持。通过对支持精神分析理论（无意识、驱力、防御机制、客体关系、恋母情结）和心理动力治疗（移情、反移情、解释、阻抗）几个主要概念的信度和效度的经验实证研究进行了回顾,也探讨了这些实证研究对心理治疗以及心理学未来的影响。     

Oedipal Shame,Rejection, and Adolescent Development

The definition of oedipal shame, dramatized in Sophocles' tragedy, is the painful affect resulting from accepting the reality of one's origins. A clinical example focusing on shame arising from adoption links oedipal shame to the theme of rejection. Furthermore, in adolescence the revival of the oedipal conflict may reactivate oedipal shame in which unconscious idealized fantasies of personal perfection and the object carried over from childhood have to be renegotiated. This process, illustrated by two clinical vignettes, may reveal entrenched masochistic defenses. An examination of a final scene from a film underscores the significance of oedipal shame in clinical practice.     

"Too late": ambivalence about motherhood, choice, and time

This paper explores a particular constellation of fantasies and defenses that in some women leads to the delay of childbearing. Destructive wishes towards the woman's own womb and her mother's lead to behaviors that sabotage fertility and pregnancy. These wishes and behaviors meet up with an unconscious belief in and commitment to time standing still, and with cultural tropes and trends that obscure intrapsychic conflicts and denials about motherhood, aging, and time. Analysis, like childbearing, is constrained by the reality of time, and the complex untangling and connecting of these three not obviously related threads may not occur until it is, for the woman who wants a child, too late.     

Contribution to the Discussion on the Analytic Frame

Our conception of the analytic frame or setting has changed over the years, partly as a necessary response to the changes in the pace and conditions of modern life, but also as a consequence of our deeper understanding of the analytic relationship and the patients' emotional needs. The shape taken by the setting at any moment of the treatment is a co-construction—partly conscious and partly unconscious—of the pair. However, the manifest setting, its impact on the parties, and its unconscious meanings are also something to be explicitly analyzed during the analytic dialogue. I present a brief clinical vignette of an analysis in which the changes in the setting, determined by external factors, later revealed their unconscious relational meaning. The various stages of this treatment were (a) a standard four-sessions-a-week analysis on the couch, (b) a condensed analysis with two double-sessions held once a week on a same day, and (c) a telephonic analysis interparsed with some occasional presential sessions. I discuss the tranference–countertransference implications of this evolution.     

Shame Veiled and Unveiled: The Shame Affect and Its Re-Emergence in the Clinical Setting

The paper examines the psychoanalytic theory of shame and the importance of developmental aspects of the shame affect. In a clinical setting, the discovery of the shame affect, stemming from unconscious and early traumatic situations, is an important and useful approach in helping the patient access painful memories and defenses against them. The defenses disguise the underlying shame affect; furthermore, vision is being bound up with the searing painful affect of shame. The anticipatory dread of scornful gaze of another person, similar to objective self-awareness can cause mortification. Fear of mortification and being exposed emerges in the clinical setting. Through the recognition of enactments in the transference and countertransference interchange, the analyst helps the patient working through them. Several case vignettes demonstrate these important concepts. Finally, the author discusses how shame in certain situations can be a powerful, positive motivator for human interactions.     

Sadism,Penetration, and the Negotiation of Desire: Commentary on Paper by Csillag

The author takes up Csillag’s idea of sadism as the wish to penetrate in the context of a patient who withholds from his analyst. With such a patient, the analyst has to bear the strain stemming from a lack of both satisfaction and recognition–the feeling of not having an impact. The defenses against sadism are examined along with the absence of intentionality in both clinical cases presented, an absence that places sadism in the realm of something that is unconscious or preconscious. Alternative views are offered on the enactment between Csillag and her patient with a focus on the unspoken negotiation of desire and (drawing on Fairbairn) the analyst’s attempt to breach her patient’s closed system of internal objects.     

The Interplay Between Therapy and Supervision

This paper examines the relationship and interplay between therapy and supervision; and how the therapist who has particular similarities to the patient brings her own armentarium of defenses as well as life problems into the therapeutic and supervisory space. The paper explores how unconscious factors from childhood become reenacted in the therapeutic space and produce emotions that affect both patient and therapist. The paper describes in detail an upward as well as downward parallel process acted out by the therapist and patient in the transference–countertransference encounter along with the supervisor's conscious and unconscious role in this process. The paper concludes by offering recommendations to beginning analytic therapists.     

Using psychoanalytic concepts to inform interpretations and direct interventions with a baby in working with infants and parents

Abstract

How can some classical Freudian concepts such as defense, transference, infantile sexuality, and the role of the body ego and superego in the first year of life be applied to help the analyst working with parent–infant dyads? The case of a newborn that could not look at her mother, who did not feel empathy towards this child conceived as a result of an egg donation, was understood using Winnicott’s notion of early superego and the lack of libidinal pleasure. The notion of defenses towards primitive anxiety and the role of unconscious maternal functioning were helpful in helping the child as well as the parents to regulate their interactions.     

The Biblical Book of Job: advice to clinicians.

Study of the Book of Job clarifies the particular adaptation to trauma that underlies the suffering of certain difficult patients. In addition, the misdirected efforts of Job's comforters in the Bible story help us understand why, with such patients, an analyst's attempts to address unconscious guilt and defenses against it will prove counterproductive. A case example is presented.     

Anatomy of Regret: A Developmental View of the Depressive Position and a Critical Turn Toward Love and Creativity in the Transforming Schizoid Personality

This article deals with critical psychic transformation in a schizoid personality disorder that evolves in an object relations psychoanalysis in which "developmental mourning" plays a central role. Within a mourning process that allows for the grieving of loss related to arrested separation-individuation development, the analysand confronts the existential grief of regret that had always unconsciously haunted her. The unconscious guilt related to the existential grief of regret had caused much dissociation of self-experience and affect states. The analysand acknowledges her own part in the destruction of primal and current relationships after the traumatic impact of her early life is understood. This allows her to repair current relationships, both within her internal and external worlds so that she can open to capacities for love and creativity. The analysand's courage to consciously grapple with her regret (loss and guilt combined) allows her to relinquish self-sabotaging character defenses such as contempt and emotional withdrawl. Consequently, a second marriage is salvaged and enriched, and the analysand's relationship with her two children is dramatically improved.