Down to cases: the ethical value of "non-scientificity" in dyadic psychoanalysis

The efficacy of the dyadic psychoanalytic method cannot be verified empirically, due to the impossibility of counterfactuals, controls, or double-blind experiments, although inventive psychoanalytic researchers have established validation methodologies for analyzing groups of case studies, outcomes, and even theoretical precepts. The unavailability of complete empirical validation for the most basic method of the discipline of psychoanalysis, or of its fundamental "report of findings"--the case study--means that the field's scientific rationale must be supplemented with public reasoning of another sort. Fortunately, the very conditions of uncertainty that make it impossible to falsify the findings of dyadic psychoanalysis lend it its ethical force by compelling its participants to confront the basic human dilemmas of freedom, meaning, and judgment, the ethical horizon of human affairs. One substantial value of psychoanalysis, then, is its capacity for generating "ethical knowledge" of the sort adumbrated by Aristotle's conception of practical knowledge (phronesis). Case studies written for a lay audience to highlight these basic dilemmas can demonstrate that psychoanalysis produces crucial knowledge, specific to individuals, for living a healthy and satisfying life.     

Feminism and Family Therapy

Feminism has had a profound effect on contemporary culture and on thinking in most academic fields, including psychoanalysis. Interestingly, until very recently it had made virtually no impact on the theory and practice of family therapy. This paper proposes an explanation for this peculiar phenomenon and argues that family therapy has been considerably handicapped by its insularity from the feminist critique. Utilizing feminist scholarship in psychoanalysis, history, and sociology, the paper analyzes the structural contradictions in family life that family therapists have essentially ignored and then outlines their clinical implications. Key points in the discussion include the argument that systems theory is an inadequate explanatory matrix from which to build a theory of the family, that the archetypal "family case" of the overinvolved mother and peripheral father is best understood, not as a clinical problem, but as the product of a historical process two hundred years in the making, and that power relations between men and women in families function in terms of paradoxical, incongruous hierarchies that reflect the complex interpenetration between the structure of family relations and the world of work. This conceptual model then provides the basis for an analysis and critique of sexual politics as they emerge in the prototypical clinical situation.     

Looking a Hundred Years Back: Remarks on the Concept of "Wishing" in Psychoanalysis

While the concepts of "wish" and "wish fulfillment" have indeed remained central since the start of classical psychoanalysis, they are only weakly anchored both in theory and practice. It has become common today for psychoanalysts to use the term "to wish" in the sense of "to want" or "to intend." As a first step, it will be emphasized that "wish" should not be constructed along the lines of "intention." An examination of the relationship of "wish" to "wish fulfillment" is then followed by an evaluation of its practical significance for psychoanalysis and for our understanding of mental life in a general sense. Turning to an example dream sequence, we will arrive at the psychoanalytic core of the issue: the assumption of hidden, non-obvious, non-recognizable wish fulfillment scenarios. At this point in the discussion, a method of access will be sketched out - the dramaturgical approach - that, although it makes use of the idea of free association, does so in a manner that diverges from Freud's original recommendation.     

Trieb und Instinkt

To say that human beings also have a self-preservation instinct just as animals is only meaningful in the sense of attachment and affection mediated by mutual communication. It is from the beginning covered up by the truly human sexual phenomena of seduction and narcissistic reciprocity. Beside that we have a sexual drive which has a more important, not to say, decisive role from birth until puberty. This latter is the subject of psychoanalysis because it is anchored in the unconscious. Finally, we also have an (innate, endogenic) sexual instinct which appears in puberty persisting the whole adult life and meets at its appearance the infantile sexual drive which was existing all the time. It is very difficult to give an epistemological definition of the (innate) sexual instinct because it does not manifest itself in a pure form, but only in unclear transactions with infantile sexuality dominating the unconscious. The subject of psychoanalysis is the unconscious and the unconscious is itself the sexuality sensu Freud, the pre-, para- or genital infantile sexuality. The sexual has its origins in the phantasy which is naturally anchored in our body.     

PSYCHOANALYSIS AND HUMAN RATIONALITY

It is clear that Freud's theories have had a profound and revolutionary impact on ideas about human nature and human rationality. However, the precise nature of that impact is less clear. It is often said that psychoanalysis reveals the irrational forces at the root of even the most apparently rational forms of thought and activity; and that, in so doing, it undermines ideas about human rationality which have dominated western thought. That is undoubtedly true. However, it is only one aspect of the truth. For the implications of psychoanalysis are more complex and far-reaching than this currently fashionable view suggests.     

High frequency long-term analysis and psychoanalytic practice. Utopia and reality

On the basis of the prognostic study of psychotherapeutic treatment in the Federal Republic and of the evaluation of more than 1000 applications for insurance benefits submitted in the years from 1973 to 1983, it is suggested that high-frequency long-term analysis is the exception rather than the rule and that it is carried on almost exclusively by a small group of "privileged" therapists. The author asks what this implies for the definition of psychoanalysis and for daily treatment practice. Are therapists being trained for a kind of treatment that they will rarely or never practice? The author urges resumption of the discussion of theory and technique of psychoanalysis in which these questions will be considered.     

Otto Fenichel and the left opposition in psychoanalysis

David Rapaport's collection of Otto Fenichel's Rundbriefe (1934-1945) is described as a recently rediscovered, 2,500-page primary source for studying the intellectual and organizational history of European-American psychoanalysis. Beginning as the confidential newsletter of the Reich-Fenichel "Left opposition" within the International Psychoanalytic Association, its function became primarily intellectual as Fenichel's group ceased to function as a caucus. It ended when its editor decided to devote himself to the struggle against neo-Freudianism within psychoanalysis, and to practice as a licensed physician.     

Evaluation and diagnosis of sexual abuse of little girls

In recent years, increasing evidence of sexual abuse of children has created a new field of medicolegal inquiry requiring a new expertise. In psychoanalysis, one of our specific tasks is to address the issues of diagnosis and of the pathogenic effect of sexual abuse as it is ultimately reflected in the intrapsychic dynamics of the developing ego. My hypothesis is that it may be possible to determine early in the treatment whether sexual abuse has taken place. The case of a two-and-three-quarters-year-old girl, suspected of having been molested by her father, is presented in depth. The evolution of material confirming the diagnosis is presented by way of documenting evidence of sexual abuse. Issues elaborating the difficulty in making the diagnosis are also explored. Finally, a synthesis of diagnostic considerations useful for arriving at a diagnosis of sexual abuse is presented in the hope that these factors will serve as diagnostic guidelines.     

The functioning of religions from a modern psychoanalytic perspective

This paper considers the personal psychological development which can take place in the adherents of certain religions, and compares it with the personal development which can take place in a psychoanalysis. The author argues that the preoccupations of different religions are very various, and to understand their functioning it is important to recognise the variety of their goals. Using the Kleinian notion of psychic ‘positions', and with the help of a neuro-scientific model, it becomes possible to conceptualise the psychological effectiveness of both psychoanalysis and the religions, and to relate them intelligibly. There continues, however, to be a radical difference between the ways in which psychoanalysis and the religions cause their psychological effects, which is best seen by considering the nature of their objects.     

The case for neuropsychoanalysis: Why a dialogue with neuroscience is necessary but not sufficient for psychoanalysis

Recent advances in the cognitive, affective and social neurosciences have enabled these fields to study aspects of the mind that are central to psychoanalysis. These developments raise a number of possibilities for psychoanalysis. Can it engage the neurosciences in a productive and mutually enriching dialogue without compromising its own integrity and unique perspective? While many analysts welcome interdisciplinary exchanges with the neurosciences, termed neuropsychoanalysis, some have voiced concerns about their potentially deleterious effects on psychoanalytic theory and practice. In this paper we outline the development and aims of neuropsychoanalysis, and consider its reception in psychoanalysis and in the neurosciences. We then discuss some of the concerns raised within psychoanalysis, with particular emphasis on the epistemological foundations of neuropsychoanalysis. While this paper does not attempt to fully address the clinical applications of neuropsychoanalysis, we offer and discuss a brief case illustration in order to demonstrate that neuroscientific research findings can be used to enrich our models of the mind in ways that, in turn, may influence how analysts work with their patients. We will conclude that neuropsychoanalysis is grounded in the history of psychoanalysis, that it is part of the psychoanalytic worldview, and that it is necessary, albeit not sufficient, for the future viability of psychoanalysis.     

Why perversion?: False love and the perverse pact1

In this paper, the author works with the awareness that perversion is a socially, historically and theologically loaded term, at the same time as it may be the latest frontier in psychoanalysis, both clinically, and in relation to contemporary art and culture which emphasize the perverse. Positioning itself against tendencies to deny the existence of a category of perversion or, inversely, to abuse it for the power that accrues from the act of diagnosing, she also points to other liabilities in the history of the treatment of this term, such as the narrowing down of perversion to the exclusively sexual domain, or, alternatively, the overextension of it to polymorphously erotic practices that enhance sexual excitement. The paradoxes of perversion and the difficulties of distinguishing the perverse from the non‐perverse are addressed. The case is also made that, in order to understand perversion, one must unlink it from the narrow notion of sexual practice and see what is involved on a deeper level an approach initiated when psychoanalysis turned to perversion as a defense against psychotic anxieties, and began considering the necessary place of perversion in the transference countertransference. Two features common to both sexual and non‐sexual perverse relations are the seductive and bribing aspects of perversion, and its means‐ends reversal. Perversion is a haven for the disguising of hatred and suspicion as excitement and (false) love. Displaced child and beating father, entitled child and seductive mother, are both prototypes of psychoanalytic refiection on parents who excite, deceive and corrupt their children and establish perverse pacts with them. The notion of the perverse pact is foregrounded in Alice's analysis, where first the resurrection and then the dismantling of such a pact were effected through various analytic means.     

What It's Like To Have a Cognitive Home

Many people believe that the mind is an epistemic refuge of sorts. The idea is that when it comes to certain core mental states, one's being in such a state automatically puts one in a position to know that one is in that state. This idea has come under attack in recent years. One particularly influential attack comes from Timothy Williamson (2000), who argues that there is no central core of states or conditions—mental or otherwise—to which we are guaranteed epistemic access. In Williamson's words, we are cognitively homeless. In this paper I will argue that Williamson's argument for the conclusion that we are cognitively homeless fails. Then I will show that there is a class of phenomenal states that constitutes a substantial cognitive refuge. When all is said and done, I will have both defended and shed light on our cognitive home.     

The dual impact of Freud's death and Freud's death instinct theory on the history of psychoanalysis

Since I have ranged over a rather large territory in this presentation I will summarize my main points. I claim that the very way Freud created psychoanalysis made it impossible for it to continue to grow and develop as a unified movement after his death. Unlike other sciences, psychoanalysis had no way of differentiating its basic findings from what is yet to be discovered. I then reintroduced my differentiation between heretics, modifiers, and extenders, claiming that after Freud’s death there was less opportunity for heretics and more space for modifiers. I assigned a crucial role to the fact that Anna Freud did not succeed in expelling the Kleinians. In the second part of the paper I presented the view of those who made use of Freud’s death instinct theory and those who opposed it. Many analysts preferred to ignore dealing with it rather than state their opposition. My presentation was biased in favor of those who chose to work with the death instinct as a clinical reality,highlighting Ferenczi’s construction. I made the claim, so far as I know never made before, that Freud’s death instinct theory had a traumatic impact on the psychoanalytic movement because it greatly limited the belief in the curative power of our therapeutic work. After his announcement of the dual-instinct theory Freud withdrew his interest in psychoanalysis as a method of cure. By doing so he inflicted a narcissistic wound on psychoanalysis. I believe that the creativity of psychoanalysis will improve if we face this difficult chapter in our history.     

Beyond his story: from interpretation to impact of stories from different cultures

This paper deals with the history of psychoanalysis (Freud) and analytical psychology (Jung) in the light of recent developments and considers the release of new creativity in the field after its deconstruction. Cross-cultural contributions in the form of teaching stories are estimated to be of relevance, while the emphasis will be on what we, as analysts, can learn from these teachings, rather than interpreting them in the more traditional way in which such stories can be shown to fit analytical theory.
The most crucial debate in psychoanalysis of the recent era centres around stories and the deconstruction thereof. It is the debate between Lacan and Derrida on the interpretation of a crucial story (Poe's story, The Purloined Letter). The core of their views will be discussed in this paper in the light of the major differences between Freud and Jung. Whereas Freud's theoretical core-complex is closely related to Lacan's phallocentric Truth, it is Derrida who speaks of germination and dissemination as the way in which Truth manifests itself. Derrida's thought on text and words is very close to Jung's conceptions of the image and symbol, in which there is no monotheistic paradigm ruling theory     

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.     

Affect availability, tolerance, complexity, and modulation in psychoanalysis: followup of a longitudinal, prospective study

Evaluation of 22 patients in supervised psychoanalysis showed that affect availability and tolerance changed in a positive direction during the course of psychoanalysis. In this study, we have defined criteria of change that can be clinically observed. The changes observed were present one year following the completion of psychoanalysis. Ratings of analysts' and patients' interviews, and ratings of psychological tests all revealed that patients had derived "therapeutic benefit" in relation to affect experience and management. Discriminations were made among changes in affect modulation, which reflected both loosening and tightening of controls, changes in affect availability, changes in experience of painful affects, and changes in experience of affect complexity. Analysts' interviews and psychological test data reflected notable changes in affect modulation in the direction of increased control, while patients' interviews more often reflected changes in the direction of increased expressiveness.     

The embodied self: thinking psychoanalytically in a time of 'science'

Abstract :  In order to be relevant in our 'scientific' times, it is necessary that we psychoanalysts situate our ideas in thoughtful and respectful relationship to neighbouring disciplines such as genetics, cultural studies, and neuro-anatomy. In this paper I suggest that, although psychoanalysis still continues to have valuable contributions to make to the understanding of human sexual experience and behaviour, in order to make these contributions relevant we must tune in with openness to the challenges posed by the unfolding discoveries in the other disciplines that grapple with the arena of human sexuality.
I will suggest ways in which research on sexual desire and gender identity may be assimilated into psychoanalytic thinking and give some examples of its use in analytic practice.     

What is psychoanalysis?

Although we are now less inclined to argue about whose treatment is entitled to be called psychoanalysis, we will understand current debates better if we revisualize what originally made psychoanalysis different from other treatments. At its birth, psychoanalysis twisted the common-sense treatments it grew out of into very peculiar shapes. In reaction to that extreme peculiarity, a process of normalizing began almost immediately and continues to this day. This process is illustrated by tracing the rise and fall of peculiarities in four aspects: medical procedure, the analyst's vision, the analyst's role, and the sense of time.     

“淑女之争”与“君子协议”:回眸英国精神分析学会的“论战”

20世纪40年代,英国精神分析学会内部爆发一场影响全世界精神分析学发展的"战争"。以Anna Freud和Melanie Klein各自为首的精神分析师团体围绕潜意识幻想、本能与力比多以及精神分析培训与教学等一系列主题展开激烈争论,即历史上著名的"Freud-Klein论战"。这场"论战"就精神分析培训问题达成协议,并直接导致克莱因学派、维也纳学派和独立学派三"组"鼎立的英国精神分析时局。"论战"促使了客体关系精神分析与自我心理学的分离,推动了精神分析研究从驱力模式向关系模式的范式转变,奠定了后续精神分析运动发展的格局。