The distinction between needs and wishes: implications for psychoanalytic theory and technique.

After a comprehensive survey of the literature is presented and some caveats entered, this paper delineates the concept of a psychological "need," noting that it bears a complex relation to the concept of a "wish." Need is universal, wish experience-bound. A need, unlike a wish, is not subject to repression. In addition, although a wish can be replaced by another wish, a need cannot be replaced by another need. Whereas the frustration of a wish causes dynamic shifts, the frustration of a need leads to structural disintegration. Needs and wishes can be in harmony or in opposition. The paper also identifies six basic psychological needs, which would seem to be ubiquitous, though the degree to which they are overt and the ways in which they are met vary across cultures. Their gratification seems necessary for healthy psychic development to occur, for relationships to survive, and for psychoanalytic work to take hold and to continue optimally. These needs are (1) the need for one's physical needs to be deemed legitimate; (2) the need for identity, recognition, and affirmation; (3) the need for interpersonal and intrapsychic boundaries; (4) the need for understanding the causes of events; (5) the need for optimal emotional availability of a love object; and (6) the need for a resilient responsiveness by one's love objects under special circumstances. Ordinarily these needs are met during the course of treatment with no deliberate effort by the analyst. In the treatment of some patients, however, they require more direct attention. A number of clinical vignettes are presented to elucidate these ideas.     

A genuinely developmental theory of sexual enjoyment and its implications for psychoanalytic technique

A small computer-assisted word frequency analysis, indicating the extent of explicit concern with sexuality in the psychoanalytic literature, has revealed an apparent decline of psychoanalytic interest in psychosexuality. The apparent decline may be related to the limitations of drive theory and object relations approaches in offering persuasive and comprehensive accounts of the psychosexual. A new model of human sexual experience is proposed, rooted in an integration of French psychoanalytic ideas with recent developmental observational research, that once again places sexuality at the center of psychoanalytic clinical inquiry. Because emotion regulation arises out of the mirroring of affect by a primary caregiver and sexual feelings are unique in that they are systematically ignored and left unmirrored by caregivers, sexual feelings remain fundamentally dysregulated in all of us. Adult sexual experience serves as a way of coming to organize the psychosexual. The model accounts for some aspects of the phenomenology of sexual arousal and suggests ways of understanding pathological distortions of sexual behavior. The nature of the psychosexual is explored in the analytic treatment of an adolescent boy.     

Conducting analysis after September 11: implications for psychoanalytic technique

The September 11, 2001, terrorist attack on the World Trade Center profoundly affected the population of New York City, including analysts and analysands. To study the effect of this event on the technique of psychoanalysts conducting ongoing analysis during the weeks after 9/11, confidential questionnaires were sent to all candidates and faculty at the Columbia University Center for Psychoanalytic Training and Research. Respondents indicated that in the days and weeks following 9/11 they initiated phone calls to their analysands, asked about their analysands' families, gave advice when it was requested, offered reassurance, and answered personal questions. They did not initiate physical contact, discontinue use of the couch, or give unsolicited advice. These responses suggest that these analysts made decisions to alter their technique in certain ways in the wake of a catastrophic event shared by the community.     

Panic attacks facilitating recall and mastery: implications for psychoanalytic technique

A patient, during the course of a lengthy analysis, experienced several panic attacks. These regressive episodes, occurring only in the analytic setting, provided her with her special means for recalling and eventually mastering repressed elements of her life. This facilitating aspect of her disorganization, when identified and analyzed as such, helped deepen the patient's analytic experience. It was necessary for the analyst to define verbally and clarify her reconstructed past as it emerged as part of her panic state, transferentially, so that the patient could finally recognize, acknowledge, and understand hitherto hidden aspects of her life. The psychiatric literature in regard to panic states is briefly noted, as is the relevance of comparing the present almost exclusively organic, pharmacological orientation, with Freud's discussion of the "actual" or current neuroses of his day, almost a century ago. On the basis of this case report, the importance of understanding the content and meaning of the panic attack, by analytic means, is once again emphasized.     

The analytic surface and the theory of technique

This paper examines the concept of the analytic surface as a starting point for the interpretive process in relation to the theory of psychoanalytic technique. The history of the concept of the analytic surface within psychoanalysis is reviewed. Four different conceptualizations of analytic surfaces are described (M.M. Gill, P. Gray, A. Kris, E.A. Schwaber). The advantages of a "surface" approach are explored in relation to clinical work, the teaching of psychoanalytic technique, and opportunities for research. Some criticisms of the concept are explored.     

The revival of "Dora": advances in psychoanalytic theory and technique

For nearly six decades after its publication in 1905, Freud's remarkable case of Dora remained untouched by critical comment. However, beginning in the early 1970's, an abundance of articles began to appear, which focused exclusively on the Dora case. The present paper reviews the literature of this so-called "Dora revival" in order to explain the historical and theoretical reasons leading to this extraordinary burst of research. Above all, two vital developments in the psychoanalytic discipline created the climate that fostered the Dora revival. First, there was a revolutionary change in attitude toward the phenomenon of countertransference: in contrast to the classical view of countertransference as a disruptive interference in treatment, analysts increasingly regarded countertransference as a pervasive and natural process, which could be potentially utilized to enhance understanding of the patient's unconscious conflicts and defenses. Second, there was enormous and rapid growth of a comprehensive psychoanalytic theory of adolescence and its treatment. Thus, based on a more favorable attitude toward countertransference, and a much improved understanding of the unique problems of adolescence, psychoanalysts could reexamine and better understand the decisive events that contributed to Freud's abortive analytic treatment of Dora.     

Ongoing change in psychoanalytic theory implications for analysis of religious experience

Hans Loewald (1980) once made the distinction between ghosts and ancestors, the former always wanting to return to the land of the living, the latter being able to rest in peace and live forth through their progeny in the present generation. Extending this metaphor, Stephen Mitchell (1991) has noted that the intellectual integrity and vitality of psychoanalysis depends on our shifting our view of Freud from an unburied ghost who haunts us to an honored ancestor. I argue that perhaps nowhere is Freud's enduring presence greater than in psychoanalytic perspectives on religion, and it is often as an unburied ghost. Ongoing change in psychoanalytic theory, however, affords respectful amendment to his work in a way that allows Freud to be a dearly honored ancestor from whom we are all psychoanalytic descendents. Three developments in psychoanalytic theory have special implication for the analysis of religious experience. These areas of change pertain to contemporary understanding of illusion, narrative, and social constructivism. I offer in conclusion seven points for further consideration.     

Tacit assumptions,countertransference and psychoanalytic technique. Part two: The influence of countertransference on theory and technique

In this article, the author examines bodily symptoms attributed to psychic mediating factors in the light of a psychoanalytic model of affect and sym- bolization. He uses clinical material from a consultation-liaison setting and a psychoanalytic treatment to illustrate how the model might help to understand different bodily symptoms as manifestations of different degrees of failure in the psychic elaboration of affect. On a more personal note, this could be seen as an attempt to understand, using a newly acquired conceptual tool, what went on in his 20 years of experience in the general hospital psychiatry setting.     

The technique of psychoanalytic therapy

This article is reproduced in translation a half century after its original presentation by Dr. Horney. It was her first psychoanalytic publication and her first article on psychoanalytic technique. In it we get glimpses of future directions of her thinking and of the spirit of research and investigation which so characterized her life's work — Editor.     

Analytic impasse and the third: Clinical implications of intersubjectivity theory

The author examines the notion of the third within contemporary intersubjectivity theory. He utilizes a variety of metaphors (the triangle, the seesaw, strange attractors, and the compass) in an effort to explain this often misunderstood concept in a clear and readily usable manner. An argument is made to the effect that intersubjectivity theory has direct implications for clinical practice, and that the notion of the third is particularly useful in understanding what happens in and in resolving clinical impasses and stalemates. Specifi cally, the author suggests that certain forms of self-disclosure are best understood as attempts to create a third point of reference, thus opening up psychic space for self-refl ection and mentalization. He provides a clinical case as well as a number of briefer vignettes to illustrate the theoretical concepts and to suggest specifi c modifi cations of the psychoanalyst's stance that give the patient greater access to the inner workings of the analyst's mind. This introduces a third that facilitates the gradual transformation from relations of complementarity to relations of mutuality.     

Model scenes: implications for psychoanalytic treatment.

Model scenes are constructed by analyst and patient to organize puzzling information, integrate previous understanding, and initiate further exploration of experience. They are derived from a variety of sources: literature (oedipal myth); transference; ordinary or traumatic childhood events that occupy a pivotal position. Model scenes may conceptualize experiences of any age and motivational system, and are contrasted with screen memories and "telescoping" of events. Two clinical examples are used to illustrate the relation between the model scene and the transference. Model scenes provide a valuable clinical tool for moving from general to specific experience. They afford empathic entry into the transference experience and the opportunity through which the experience of motivations representative of past and present can be conceptualized and integrated into a cohesive self organization.