After pluralism: Towards a new,integrated psychoanalytic paradigm1

After a restatement of the isolationism of psychoanalysis from allied disciplines, and an examination of some of the reasons for the diversity of schools of thought and the fragmentation of psychoanalytic knowledge, the author suggests the need to adopt principles of correspondence or external coherence along with those of hermeneutic coherence to validate psychoanalytic hypotheses. Recent developments in neurocognitive science have come to the aid of psychoanalysis in this period of crisis, resulting in the proposition of integrating both areas to form a new paradigm for the construction of the theory of the mind. This emerging paradigm tries to integrate clinical knowledge with neurocognitive science, fi ndings from studies on the process and outcome of psychotherapy, research into the early mother‐infant relationship, and developmental psychopathology. The author examines theoretical‐ technical models based on the concept of drives and of relationships in the light of interdisciplinary fi ndings. He concludes that the relational model has a broad empirical base, except when the concept of drives is discredited. Interdisciplinary fi ndings have led to the positing of the replacement of the Freudian model of drives with a model of motivational systems centred on affective processes. He draws certain conclusions which have a bearing on the technique of psychoanalytic treatment. These arise from the adoption of the new integrated paradigm.     

Grasping psychoanalysts’ practice in its own merits1

The central objective of this presentation is to reflect on the obstacles involved in the task proposed by the Chicago Congress, which is to explore convergences and divergences in psychoanalytic practice. The author discusses two major obstacles. First, the epistemological and methodological problems in relation to the construction of theory in psychoanalysis and especially the inaccessibility, in any reliable way, of what psychoanalysts really do in the intimacy of their practice. He proposes to separate, at least in part, theory from practice in psychoanalysis, in an attempt to grasp psychoanalysts' practice in its own merits. He then outlines a phenomenology of the practice of psychoanalysis, which reveals that, in their work with patients, analysts are guided more by practical reasons than theoretical reasons; that is, their interventions are predictions rather than explanations. Since these practical reasons need to be validated constantly in the analytic relationship based on their effects, he discusses the subject of validation in the clinical context of the core theory of therapeutic change in psychoanalysis, that is, the conditions required for clinical practice to satisfy the thesis of an inseparable union between gaining knowledge and cure. He ends by challenging the core of the psychoanalytic theory of change, arguing that it neither does justice to the practice of psychoanalysts nor to contemporary knowledge of processes and mechanisms of therapeutic change. Finally, he proposes that we detach practice from theory, in order to study the former in its own merits, utilising a plurality of methods ranging from systematic investigation to the recent methodology of the Working Party.     

A psychoanalytical phenomenology of perversion1

After stating that the current tasks of psychoanalytic research should fundamentally include the exploration of the analyst's mental processes in sessions with the patient, the author describes the analytical relation as one having an intersubjective nature. Seen from the outside, the analytical relation evidences two poles: a symmetric structural pole where both analyst and patient share a single world and a single approach to reality, and a functional asymmetric pole that defines the assignment of the respective roles. In the analysis of a perverse patient, the symmetry‐asymmetry polarities acquire some very particular characteristics. Seen from the perspective of the analyst's subjectivity, perversion appears in the analyst's mind as a surreptitious and unexpected transgression of the basic agreement that facilitates and structures intersubjective encounters. It may go as far as altering the Aristotelian rules of logic. When coming into contact with the psychic reality of a perverse patient, what happens in the analyst's mind is that a world takes shape. This world is misleadingly coloured by an erotisation that sooner or later will acquire some characteristics of violence. The perverse nucleus, as a false reality, remains dangling in mid‐air as an experience that is inaccessible to the analyst's empathy. The only way the analyst can reach it is from the ‘periphery’ of the patient's psychic reality, by trying in an indirect way to lead him back to his intersubjective roots. At this point, the author's intention is to explain this intersubjective phenomenon in terms of metapsychological and empirical research‐based theories. Finally, some ideas on the psychogenesis of perversion are set forth.     

The competent psychoanalytic supervisor: Some thoughts about supervision competences for accountable practice and training

What are the competences required to satisfactorily practice effective or “good enough” psychoanalytic supervision? In this paper, I would like to consider that question. Over the past approximate 15-year period, increasing attention has been directed toward more specifically identifying and defining the components of competent psychoanalytic practice. But any parallel attention toward identifying and defining the components of competent psychoanalytic supervision practice has, in comparison, been sorely limited if not virtually absent. If we are to best practice competent psychoanalytic supervision and best train future psychoanalytic supervisors for competent practice, effort needs to be made to concretely delineate the competences that are requisite for such practice. In what follows, I present and adapt six broad-based families of internationally relevant supervision competence areas for use in psychoanalytic supervision: (1) knowledge about/understanding of psychoanalytic supervision models, methods, and intervention; (2) knowledge about/skill in attending to matters of ethical, legal, and professional concern; (3) knowledge about/skill in managing psychoanalytic supervision relationship processes; (4) knowledge about/skill in conducting psychoanalytic supervisory assessment and evaluation; (5) knowledge about/skill in fostering attention to difference and diversity; and (6) openness to/utilization of a self-reflective, self-assessment stance in psychoanalytic supervision. Although by no means an exhaustive list, 30 supervision competences (five per family) are proposed as significant for guiding competent psychoanalytic supervision practice and supervisor training, and a brief explanatory comment is offered in support of each broad-based family of competences.     

Cultural function and psychological transformation in psychoanalysis and psychoanalytic psychotherapy

Cultural experience of silence and individual vicissitudes between talking and being silent infl uence the way individuals form an alliance and pursue the analytic process. This is of relevance both for the patient and for the psychoanalyst/therapist. The author describes a patient, whose silent phase occurred in the fi fth and sixth year of intensive psychoanalytic psychotherapy. She suggests that a) the silence functioned as a protection of a space for the core self and promoted inner transformation and psychologicaldevelopment;b)thesilenceinvolvedatransference-countertransference matrix with projective identifi cations of the patient's internalized mother- and father-related objects that caused a tenuous balance between maintaining and erasing the relationship between the patient and the author; c) the silence phase was highly infl uenced by the author's own cultural background and what she brought into the relationship of tolerance of being silent in the presence of another, and understanding of the many complex functions of silence. During the silent phase the patient moved from simply describing and naming her affects and inner experiences or expressing them as somatic processes, to being able to internally access and verbally convey her own affects and experiences in the therapeutic alliance. This process involved both affect desomatization, affect differentiation, and affect verbalization.     

One-person and two-person conceptions of attachment and their implications for psychoanalytic thought

There has been increasing interest among analysts in the possibilities of enriching psychoanalytic thought through fuller incorporation of attachment theory and research. This paper offers a clinical illustration of the ways in which attention to an attachment perspective can lead to novel and useful ways of addressing the patient’s issues. It also presents a number of cautions that it is necessary to be alert to if attachment thinking is to achieve its full potential in advancing psychoanalytic thought and practice. Conceptions of attachment and approaches to its study and clinical use actually vary quite substantially. Some are more one-person, static, and categorical. Others are more two-person, dynamic, and focused on the process whereby attachment patterns develop and are maintained over time. This paper explores the distinction between these two versions of attachment theory and research with two aims in mind – first, to refine our understanding of the potential role that attachment thinking can play in advancing the psychoanalytic paradigm; second, to utilize the insights achieved through examining the attachment paradigm to consider some broader issues in the construction of psychoanalytic theory more generally and its relational variant in particular.     

A systematic review of the effectiveness of psychoanalysis,psychoanalytic and psychodynamic psychotherapy with adults with intellectual and developmental disabilities: progress and challenges

Objectives: This systematic review aimed to critically appraise the literature on the efficacy and effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy in adults with intellectual and developmental disabilities (IDD). Method: A systematic search of electronic databases was carried out. The methodological quality of the studies was assessed using a quality assessment tool and comparisons were made with a review of the quality of research on the effectiveness of cognitive behavioural therapy (CBT) for people with IDD. Results: The search yielded 13 papers which provided evidence for the effectiveness but not efficacy of psychoanalytic and psychodynamic psychotherapy; but none were found for psychoanalysis. The quality of the research was generally poor compared to the current research on the effectiveness of CBT. Conclusions: Positive outcomes have been indicated for psychoanalytic and psychodynamic psychotherapy with people with IDD. Larger scale, more controlled research is necessary to advance the evidence base.     

Current developments in the practice of individual psychoanalytic psychodrama in France

The authors present the history of individual psychoanalytic psychodrama and its current developments as practised in France. They put forward the technique, objectives and rules, along with the indications, limits and risks that ensue from the specific nature of this therapeutic approach. Through its technical adjustments, individual psychoanalytic psychodrama provides a therapeutic option that is appropriate to the defences prevalent in many patients that cause classical psychotherapies to fail: massive inhibition, operative functioning far removed from affects or in false self mode; phobias, disavowal or splitting of the internal psychic life and emotions; prevalence of short discharge circuits in acted-out behaviours and bodily or visceral complaints and expressions. Psychodrama utilizes these defences not in order to eliminate them but to 'subvert' them so that they can continue to carry out their protective role, in particular ensuring narcissistic continuity. At the same time, psychodrama relaxes these defences and facilitates a possible filtering through of the repressed material. Through the number of actors and the diffraction of transference that this allows, psychodrama provides a possibility of adjusting the potentially traumatic effect of the encounter with the object and the instigation of the transference in the regressive dimension induced by any psychotherapeutic process.     

Transferences in parent–infant psychoanalytic treatments

In parent–infant treatments, babies sometimes exhibit symptoms such as screaming, clinging, and fearful gaze avoidance of the analyst. The paper investigates if such phenomena may be regarded as transference manifestations, and if so, if they appear both in younger and older infants. Based on three case presentations, it is concluded that some babies are capable of forming both brief and enduring transferences. The term “indirect infant transference” refers to when a baby reacts emotionally to the analyst as long as the parent's transference remains unresolved. “Direct transference” refers to when a baby reacts in a non‐mediated way to the analyst. The necessary tool of investigation for discovering these phenomena is a psychoanalytic method with an explicit, though not exclusive, focus on the baby. Discerning them in the clinical encounter may help us understand the baby's predicament and when and how to address the baby or the parent. These treatments constitute an empirical field awaiting more extensive clinical and theoretical investigation. Already now, they suggest that transference may be rooted in, and may appear during, very early developmental stages. The paper's positions are compared with those put forward by other parent‐infant clinicians.     

Matte Blanco's thought and epistemological pluralism in psychoanalysis

It can be seen that, although psychoanalytic pluralism is widespread, there is still a spirit of intolerance among the different theoretical schools. Matte Blanco's work allows us to think about these questions in a fresh way. Direct psychic experience, felt to be an indivisible whole, is characterized by the symmetrical mode (close to the unconscious) and projects itself in a multiple and decondensed manner on to the asymmetrical mode (consciousness, thought). Thus, psychical facts (for example, what the patient says and feels during the session) can be accounted for by multiple conscious representations which, however, are not mutually contradictory (e.g. in different theoretical approaches). Affective factors linked to the hope of reviving 'oceanic feelings' of fusion with a unified and unifying theory of the subject-analyst are also explored insofar as they lead to the tendency of analysts to exclude one another.     

The psychoanalyst's normal and pathological superegos

The first section of the paper explores a number of differing views regarding the concept of the superego, essentially in terms of its formation and its functions. Two broad theories of superego development, both of which were introduced by Freud, are described. The first takes the superego to be principally oedipal in origin; the second traces the superego to an earlier period. The controversy about the usefulness of the concept of the death instinct is also implicated in the different views. It is then suggested that it is worthwhile to distinguish between a normal superego and a pathological superego and that these two distinct models of the superego are implicit in the work of both Freud and Klein. Strachey's (1934) views on the nature of the mutative effect of psychoanalytic treatment are briefly reviewed in the light of this distinction. It is suggested that Strachey was hesitant in clarifying the full implications of his views, particularly regarding the reasons for the difficulty the psychoanalyst will experience in making a transference interpretation. It is argued that the difficulty will relate to the psychoanalyst's anxiety about having sufficiently worked through the countertransference, particularly in relation to superego functioning. Two brief clinical vignettes are considered in support of this view. The last section of the paper offers some comments on the emotional development of the psychoanalyst and the ways that maturing as a psychoanalyst will involve a certain mellowing of the analyst's stance and a greater tolerance of the patient's prerogative to bring the full range of his or her personality into the treatment.     

Why Ferenczi today? The contribution of Sándor Ferenczi to the understanding and healing of psychic suffering

A society undergoing rapid change, which doubts its own possibilities of survival, calls into question the worth of psychoanalytical theory and practice. The author emphasizes that the Ferenczian clinical evolution could be a source of inspiration for reinvigorating our trust in the prodromes of the Freudian paradigm, and thus for relaunching the authoritativeness of our thought and our psychotherapeutic method. In this light the author examines the affective and cognitive qualities that render Ferenczi a mentor of our possible future development, taking into consideration the following aspects: the communicative and intersubjective perspective that denotes Ferenczi's thought since his first writings; the receptive, reflective, and self‐reflective capacities which have progressively accompanied his own commitment and clinical attitude; and his elective work on trauma and “the traumatic”, including the algogenic messages transmitted during the healing process by analysts in fear (and perhaps terror) of their own regression and countertransferential catastrophe. In particular, these last events (central in the Ferenczian vision) are today specifically stimulated by new forms of pathology which search for, with our help, a resolution of the apathetic pain and the tearing apart of the identity that characterize the suffering of patients.     

The feigenbaum scenario in a unified science of life and mind

In exploring the possibilities for creating a model of the creative cosmos, it is important to seek mathematical models that can express the common relationships unifying the sciences of matter, life and mind. Current candidates for such all embracing mathematical models come from the burgeoning fields of non‐linear dynamics that are described under varying labels as Chaos Theory, Self‐Organization Theory and Adaptive Complexity Theory. In this paper we will limit ourselves to only one mathematical model called, “The Feigenbaum Scenario.” A major virtue of The Feigenbaum Scenario is that it is relatively easy to understand by non‐mathematicians and it has led to new depths of profound understanding in a wide variety of the physical and biological sciences. Everything from purely mechanical systems, fluid dynamics and the weather to the patterns of biological growth in nature and the dynamics of heart, hormone and brain rhythms have been found to exhibit aspects of the Feigenbaum scenario. We explore the possibility that the Feigenbaum scenario can be extended to experiences of mind, sensation, perception and human behavior as well. We conclude that a major function of consciousness may be to transform the non‐linear, irrational, unconscious and difficult to predict dynamics of unconscious nature into the more linear, rational and predictable psycho‐dynamics that make human experience and social life possible.     

The interior and the abject: uses and abuses of the female in the middle ages

In this paper I argue that during the High Middle Ages definitions of the female as distinct from the life led by women played a crucial role in defining social boundaries and solidifying new systems of power. I suggest that there were two female figures that were crucial to these definitions: the mother and the virgin. While the mother image was invoked to describe the internal functioning of the Christian community, the virgin metaphor drew the external boundaries and defined the Christian community's relation to the non‐Christian other.     

Religious pluralism and processes of individualisation in Hinduism

The paper explores the interconnection between religious pluralisation and processes of individualisation in India by focusing on the emergence of religious alternatives to Vedic ritualism in the centuries around the beginning of the Common Era. Criticism of established religious goals and practices voiced by individuals was accompanied by an increasing interest in the structures of individual existence. The conceptualisation of the individual in the philosophical and religious literature of the period is an important aspect of establishing new religious pathways with ideas of self, agency and personal relatedness being of central concern. On the basis of different doctrines religious options gained acceptance which allow individuals to pursue their religious aspirations either apart from or parallel to the ritual-social obligations in the context of caste-hierarchy. The new religious options gravitate towards institutionalisation in the form of religious communities (sampradāya). These are not only important elements in organising Hindu religious pluralism, but also allow for recurrent processes of religious individualisation.     

Convergence,commonality, and context in psychoanalytic supervision

ABSTRACT

What are the binding commonalities that demark and define any and all psychoanalytic supervision perspectives? What do we all do as psychoanalytic supervisors that practically matters? Furthermore, might there be a unifying model that anchors those binding commonalities together into a supervision meaning-making, explanatory framework? In this two-part paper, I take up those questions. In Part I, based on a century-spanning literature review, I identify 50 (non-exhaustive) common Support and Learning factors that appear present across the panoply of psychoanalytic supervision perspectives. Relational, educational, and interventional, these 50 factors reflect the very stuff of which psychoanalytic supervision is made. In Part II, I present and elaborate upon the Contextual Psychoanalytic Supervision Relationship Model (CPSRM) – a theoretically-grounded model that anchors and contextualizes those common Support and Learning factors. Because common factors can be seen as nothing more than atheoretical amalgamation (i.e., lists of desirable characteristics endlessly strung together), the CPSRM is proposed as a theoretically-based antidote. A supervisory extrapolation of Wampold’s contextual psychotherapy relationship model, the CPSRM accentuates relational connection, expectations/goals, and educational action as preeminently supervisee change inducing and learner affecting.     

Light and color in a void: The analysis of a special needs child

This clinical report comes from the five year, four day a week analysis of a male child. What is special is that this treatment is of a child with marked mental retardation. I have retained this nomenclature because that is how Ricardo's parents described his mental capacity. What they meant was that he was greatly impaired in his cognition and this could be seen in Ricardo's severe cognitive, social, behavioral, and relational improprieties. I have privileged the function of psychoanalytic understanding and the role of transference to bring about modifications in this child's internal world. And I have considered the patient's psychotic mental state to be in need of psychoanalytic treatment not withstanding his psychosis's connection to his cognitive handicap. I have also added information I have received after the analysis, information that demonstrates continued integration coming from the analytic process. Owing to Ricardo's limited mental capacities, this article advances clinical information that is not often found in analyses of children. There are possibly many other children like him who nonetheless would benefit from dynamic psychoanalytic understanding. On the other hand, I shall not discuss this matter theoretically, even though some theoretic considerations are necessary. Clinical practice and the transferential relation are this report's principal material.     

Inside and outside the window: some fundamental elements in the theory of psychoanalytic technique

The underlying concern of this paper is that psychoanalysis as practised today is in danger of losing its specificity and so losing its way. The author suggests this is possible for three reasons: the problem analysts face in responding to the strong emotional demands the great majority of patients necessarily place on them, the unintended consequences of the apparent success of 'here and now technique' and the absence of good clinical theory. The paper mainly discusses the author's ideas about some core elements of the clinical theory that all psychoanalysts must use when they are working and proposes (at the risk of being facile) some relatively simple heuristics related to them which are meant to be helpful. Recalling Kurt Lewin's maxim that 'there is nothing so practical as a good theory', he will suggest that continuous reflection on how one is using theory in daily practice is highly practical, if the theory is good enough. Theory in fact is a necessary 'third' in psychoanalytic practice which, if kept in sufficient working order close enough to clinical experience, provides an ongoing and very necessary check on our sense of reality. But, of course, as a third it can, like reality itself, be the focus of both love and hate with equally problematic consequences. The paper starts with a clinical example of a difficult but apparently successful analysis reaching its end, which will be used throughout the paper to illustrate and elaborate the theoretical ideas set out.     

Transcending the evidentiary boundary: Prediction error minimization,embodied interaction,and explanatory pluralism

In a recent paper, Jakob Hohwy argues that the emerging predictive processing (PP) perspective on cognition requires us to explain cognitive functioning in purely internalistic and neurocentric terms. The purpose of the present paper is to challenge the view that PP entails a wholesale rejection of positions that are interested in the embodied, embedded, extended, or enactive dimensions of cognitive processes. I will argue that Hohwy’s argument from analogy, which forces an evidentiary boundary into the picture, lacks the argumentative resources to make a convincing case for the conceptual necessity to interpret PP in solely internalistic terms. For this reason, I will reconsider the postulation and explanatory role of the evidentiary boundary. I will arrive at an account of prediction error minimization and its foundation on the free energy principle that is fully consistent with approaches to cognition that emphasize the embodied and interactive properties of cognitive processes. This gives rise to the suggestion that explanatory pluralism about the application of PP is to be preferred over Hohwy’s explanatory monism that follows from his internalistic and neurocentric view of predictive cognitive systems.