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.     

Clinical Implications of Unconscious Communication in the Analytic Dyad; Towards a Deeper Therapeutic Engagement

ABSTRACT

In this article, clinical examples focus on unconscious communication between patient and analyst which take the form of physical sensations, dreams, temporarily debilitating shared grief, deep immersion in dissociated affect and shared trauma.     

Being, thinking, creating: when war attacks the setting and the transference counter-attacks

When trauma enters into the reality of the analyst and of the analysand, when it attacks the setting, what becomes of the analyst’s role? How can transformations be brought about? With reference to three clinical situations, the author attempts to explore how the articulation between transference and countertransference – the inter‐relation – structures the situation; the analyst must remain in his or her role as analyst through managing to create and to reflect upon the clinical aspects of that situation when faced with the unpredictability of what war brings in its wake. It then becomes possible to see how the work of the negative can be confined to the outer limits of the setting.     

Witch-mother is which? The potential role of the analyst in facilitating authentic motherhood

Abstract

This paper explores challenges in the treatment of women suffering from disturbances in maternal identification. A review of the psychoanalytic and developmental literature focuses on the frequent finding of early-onset mother–daughter relational disturbance involving maternal narcissistic fragility and exaggerated dependency needs, intergenerational trauma, and related psychopathology including mutual affect dysregulation. A case example of a young woman with a severe anxiety disorder is presented and discussed to illustrate the challenges to the traditional psychoanalytic technique. This patient avoided pregnancy into her late thirties and entered analysis with feelings of inauthenticity, characterological masochism, and a “secret mission” to unmask the witch recurring in her dreams. Through an elaborate working-through of negative maternal transference, the analyst and patient saw through the birth of the patient’s authentic self, a new approach to her career, her relationships with men, and her anticipation of the birth of a child by the sixth year of treatment. The author posits that psychoanalytic technique benefits from contemporary, attachment, and trauma research that supports the analyst’s playing a more active role in approaching, co-regulating, tolerating, and integrating avoided affects and memory traces that are associated with early-onset relational disturbances worsened by the effects of violence, maltreatment, and loss.     

The Colonized Mind: Gender,Trauma, and Mentalization

The question of how gender and trauma may impact one another is explored through detailed clinical material from the author’s work with a patient contemplating, and then beginning, a transition from female to male. The author explores what happens when a mind is colonized rather than mentalized. The term colonize is used to describe the unconscious use of a child’s mind to store unprocessed trauma from an earlier generation. The author describes destabilizing feelings of uncertainty, shame, and anxiety in both patient and analyst at various points in the treatment.     

Dissociation,the Analyst's Vulnerability,and the Body: Review of Awakening the Dreamer: Clinical Journeys by Philip M. Bromberg

This review praises Bromberg's rich and evocative new book for its clinical and theoretical usefulness and elaborates on three broad themes: the analyst's personal role in traumatic enactments, dissociative/addictive uses of the body, and the distinction between life-threatening and developmental trauma. Extending Bromberg's formulations, the author argues that in successful work with trauma survivors, the analyst must be actually (temporarily) traumatized as actual, personal vulnerabilities of the analyst are necessarily engaged. The analyst's vulnerability serves as an internal contact point, opening up a process of unconscious empathy with the patient and providing crucial validation of the patient's experience. The review also explores how bodily processes are used to further dissociation with eating disordered patients and how they become the source of treatment difficulties. When the patient's states of desire have been “detoured” into the body (where they are ruthlessly controlled or attacked) as well as into the relationship with food (where they are temporarily gratified), they are not as available to be mobilized in the analytic relationship. The review also questions Bromberg's assumption that the underlying dissociative mechanisms are the same for life-threatening trauma (or Posttraumatic Stress Disorder) and developmental (or relational) trauma.     

Attention and Narration to Micro-Moment Registrations of Embodied Dialogue in the Clinical Interaction: How Are We Doing?

ABSTRACT

This article offers a comparison between two different strategies for clinical attention. The author compares his lens shaped by a musical metaphor of “polyrhythmic patterning” on embodied registrations which he describes as “fluidity” in contrast to a lens of structures or categories of experience. He then contrasts this lens to that offered by Lewis which she describes with the metaphor of an “imaginary camera” with which she creates “snapshots” as representations of unbearable (and often unformulated) trauma shaped by the patient's narrative and her own trauma history. Acknowledging the exquisite connection between analyst and patient, the author uses 2 clinical moments to further illustrate the benefits of each metaphoric lens for possible analytic work.     

Empty Depth,Empty Breadth,and the Forging of a Therapeutic Alliance

This paper describes a case in which analyst and analysand became interlocked in battles that drew out the 'mad' parts of each other. It explores how the extreme conflict may have actually been an integral part of what has become a truly therapeutic process for both. Theoretically, the dialectical movement of becoming through contradiction is used to help explicate how mutually destructive enactments were necessary building blocks of genuine intimacy.     

Enactment as Unconscious Communication

ABSTRACT

I explore the way in which unconscious primitive and nonsymbolic experience is communicated to the analyst’s unconscious through enactment. As the analyst receives the projections unconsciously, she is encouraged to enact aspects of the patient’s internal world. The analytic work then is through the understanding of these subtle and ubiquitous enactments. I value the work of understanding enactments as a rich and subtle pathway into the deepest levels of the patient’s unconscious. I explore the nature of this work and illustrate my point with clinical examples.     

Narratives of trauma,recovery, and growth: The complex role of sport following permanent acquired disability

ObjectivesThe purpose of this study was to explore how participation in sport may assist an individual in working through experiences of physical trauma.DesignAn instrumental, collective case study was used to illustrate the experiences of two men with acquired disabilities.MethodBoth men participated in sport at a high level and suggested that participation was a central feature of their recovery from trauma. Interviews invited participants to describe their lives pre-trauma, the trauma experience, and the recovery process. A narrative analysis was used to focus on the progression of the plot outlined in each participant's story.ResultsOur results exemplify two narrative types: assimilation and positive accommodation. The narrative of positive accommodation demonstrates how sport provided mastery experiences, enhanced relationships, corporeal understanding and enhanced life philosophies. The alternative narrative of assimilation was associated with resilience to trauma. Our case illustrates that such a narrative may be focused on re-capturing previous life meanings and creating an athletic identity using past definitions of sport.ConclusionWhile the narrative of positive accommodation is most frequently associated with posttraumatic growth, our case outlines the occurrence of synchronous positive and negative experiences, even within the same dimensions of growth. The narrative of assimilation demonstrates the challenges presented by the rehabilitation and sporting environments for an individual who aimed to restore their pre-trauma self and pre-trauma beliefs.     

Subjectivity,complexity and the social world Erikson's identity concept and contemporary relational theories

In its psychic action, the writing and revelation of Janine de Peyer's essay create a parallel process for the reader that must reflect the uncertain pleasures and unsettling demands of the case itself. By taking us into the intimate vortex of therapeutic work with this sexually aggressive and traumatized patient, the author is challenged to write with sufficient specificity to illuminate the psychic and technical demands on the analyst without lapsing into a confessional narrative that defaults into a subtle exhibitionism—a genre that allows the reader to evade the work of identification by becoming an ambivalent voyeur instead. Holding the tension between these two positions in treatment and in writing about such treatment is the focus of this commentary.     

Relational treatment of a borderline analysand

Abstract

This paper, in case material, examines the role of the analyst is co-creating the sado-masochistic enactments so common in the transference/countertransference with borderline analysands. Emphasis is placed on how to resolve the enactments so that a new paradigm is created based on trust and cooperation.     

Therapeutic Work with Trauma,Revictimization, and Perpetration: Bearing Witness,Offering Hope,Embracing Despair

ABSTRACT

This paper offers a case study of a survivor of childhood incest who in adulthood has become a victim of violence in her relationships with chosen partners and is concerned that she herself may be a perpetrator of sexual abuse. It examines selected literature on attachment, dissociation, transference/countertransference, role responsiveness and sadomasochistic therapeutic enactments, the two-system superego model, and the triadic self. The paper focuses on long-term treatment dynamics with survivors of cumulative trauma and explores such psychodynamic psychotherapy issues as the therapist as a perpetrator of violence, the development of sacred space, authenticity, and the importance of both offering hope and embracing despair in this work.     

Fromm's Spirited Values and Analytic Neutrality

The analyst and the patient must feel enough hope to sustain their active effort. A significant aspect of the analyst's role is inspiring hope. This seems to require that the analyst take a life-affirming position that violates traditional notions of analytic neutrality. Yet, in facilitating the patient's full self-expression, we do not want to lose the benefits of neutrality. Fromm's work can inspire us to try to integrate an attitude of spirited hope with interpretations whose content neutrally encourages the patient to reveal his whole self.     

Seduction,date rape,and aborted surrender

Abstract

This paper clarifies the dual-layered nature of the “demon lover complex,” with its background of both pre-Oedipal trauma and Oedipal-level desire. It draws on an object relations understanding of the unconscious and dissociated addiction to an internal demon object that has derivations in the personalities of the actual parents, and in the internalization of these parents. The dramatic case of early trauma compounded by adult date rape trauma serves to illustrate how a “developmental mourning process” in treatment can resolve such trauma. It also illustrates how reparation with the mother that partially heals pre-Oedipal trauma cannot immunize anyone against Oedipal-level attractions to a “demon lover” father, as represented in a displacement, resulting in victimized behavior, and in an aborted surrender to heterosexual desire. However, this victimization can be resolved, as seen in the clinical illustration, when the psychoanalyst has an understanding of the mourning process in developmental terms, working with a natural interaction between mourning and transference evolutions in treatment. The case also demonstrates the transitional object role of the psychoanalyst who is involved with the healing of pre-Oedipal trauma through mourning.     

Distinction between mental pain and psychic suffering as separate entities in the patient's experience

Abstract

Mental pain and psychic suffering are herein defined as two separate concepts in psychoanalysis. The concept of mental pain lies at the core of psychoanalysis; it was introduced by Freud and was further elaborated by a number of investigators, mostly by Bion. Mental pain refers to a pain that the patient reports as being impossible to describe in words, and lacking any associations, whereas psychic suffering can be both named and described by the patient. Mental pain is derived from non-tolerance on the part of the psychic apparatus when it is harmed by very painful emotions. In contrast to psychic suffering, mental pain resists elaboration and transformation by dream-work. How to address and transform the patient's mental pain is a major challenge facing the analyst in his clinical work because mental pain may halt or slow the progression of the analytical process. To overcome this hindrance, the work of the analyst is focused on helping patients to modify their mental pain into psychic suffering, that is, to reactivate in the patient the chain of transformations that generates thought. The analyst is also challanged with the mental pain of the patients because he has himself to tolerate the mental patient induced by counter transference. Suggestions for the analyst on how to deal with the mental pain of the patient during psychoanalytic therapy are proposed.     

The Imp in the iPhone

ABSTRACT

A case vignette involving contemporary communications technology—an iPhone, a computer, digital photos, and Skype—suggests that unconscious communications are not only repetitions of the patient’s ongoing experience and dynamics, but may also be prospective, expressing emerging emotional and psychological potentials that were previously unavailable to the patient. These communications may also provide direction for the treatment via the analyst’s countertransference fantasies and responses. It is also suggested that these bidirectional communications are shared between patient and analyst through an unconscious field akin to what Jung posited as a collective unconscious.     

Social criticism in the process of interpretation (discussion)

Abstract

The author comments on Horst Petri's case presentation and gives reasons why he sees social criticism within the process of interpretation as inappropriate. Firstly he contradicts Petri's view of the severity of his patient's illness. He thinks a supportive therapy was not appropriate and he would have treated her by using conflict centered interpretations. Secondly he assumes that the analyst's social criticism forms an alliance with the analysand which excludes essential issues from the analytic work. And thirdly he reminds us that psychoanalysis doesn't spare a supposedly progressive attitude from criticism. Within the framework of psychoanalytic theory, the relativity of all value judgements forbids the analyst to tie himself down in the way Petri suggests.