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.     

WITHSTANDING TRAUMA: THE SIGNIFICANCE OF EMMA ECKSTEIN'S CIRCUMCISION TO FREUD'S IRMA DREAM

The author considers the medical rationale for Wilhelm Fliess's operation on Emma Eckstein's nose in February 1895 and interprets the possible role that this played in Freud's dream of Irma's injection five months later. The author's main argument is that Emma likely endured female castration as a child and that she therefore experienced the surgery to her nose in 1895 as a retraumatization of her childhood trauma. The author further argues that Freud's unconscious identification with Emma, which broke through in his dream of Irma's injection with resistances and apotropaic defenses, served to accentuate his own “masculine protest”. The understanding brought to light by the present interpretation of Freud's Irma dream, when coupled with our previous knowledge of Freud, allows us to better grasp the unconscious logic and origins of psychoanalysis itself. 1     

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.     

Trauma and the Unconscious: Double Conscience,The Uncanny and Cruelty

Relatively little has been written on the role of trauma in conceptions of the unconscious. This paper explores Freud’s conceptions of the unconscious, comparing his ideas with the original French notion of “double conscience” and exploring their implications for technique. Whereas Freud’s concept of the unconscious mainly depends upon a theory of internal drives, Ferenczi’s ascribed a central role to trauma, shifting the focus to the individual in the context of relationships. The comparison is illustrated with a case history.     

A Closer Look at Couple Collusion: Protecting the Self and Preserving the System

Couple collusion is the term used to describe a group of defenses that some spouses use to protect their respective selves and to preserve dyadic equilibrium. Collusive defenses can take a variety of forms, such as conscious agreements, non-verbalized pacts, and unconscious contracts. In this article, the author describes two unconscious collusive defenses: (a) acting out and (b) monitoring and restraining. He offers some suggestions for dealing with these defensive systems in two case studies.     

Dissociative Collusion: Reconnecting Clients with Histories of Trauma in Couple Therapy

This paper introduces the concept of “dissociative collusion” as a helpful theoretical and clinical tool for understanding and working with clients with histories of trauma in couple therapy. The paper describes ways to diagnose and treat dissociative collusion based on the integration of an object relations approach, a relational approach, and a narrative approach. Dissociative collusion, a unique version of the well‐documented “couple collusion,” describes relational unconscious dynamics where split‐off aspects of one or both partners are mutually dissociated in a complementary fashion that becomes a part of the shared unconscious and is reenacted in destructive ways. The dissociative collusion concept is especially relevant to couple therapists who work with clients with histories of trauma, who frequently use dissociation as a primary defense mechanism. We suggest that the challenge and goal for couple therapy with this population are to help them reconnect and better oscillate between dissociated self‐other configurations. A case of couple therapy of a wife who had been a victim of childhood sexual abuse and her husband who displayed frequent use of dissociative defenses is presented.     

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.     

Conscious and unconscious face recognition is improved by high-frequency rTMS on pre-motor cortex

Simulation process and mirroring mechanism appear to be necessary to the recognition of emotional facial expressions. Prefrontal areas were found to support this simulation mechanism. The present research analyzed the role of premotor area in processing emotional faces with different valence (positive vs. negative faces), considering both conscious and unconscious pathways. High-frequency rTMS (10 Hz) stimulation was applied to prefrontal area to induce an activation response when overt (conscious) and covert (unconscious) processing was implicated. Twenty-two subjects were asked to detect emotion/no emotion (anger, fear, happiness, neutral). Error rates (ERs) and response times (RTs) were considered in response to the experimental conditions. ERs and RTs decreased in case of premotor brain activation, specifically in response to fear, for both conscious and unconscious condition. The present results highlight the role of the premotor system for facial expression processing, supporting the existence of two analogous mechanisms for conscious and unconscious condition.     

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.     

Abusive families and character formation

Family research studies confirm that abusive parents tend to be undifferentiated partners who compete with each other and with their children for attention and nurturance. More or less healthy parents make demands on children to counteract their own injured narcissism, but they do so largely without devaluation and the sadistic use of projective identification. Under sufficient stress abusive parents attack the child who fails to gratify their needs, thereby giving vent to longstanding frustrations and feelings of being threatened by the child's individuation and competency. The emotional atmosphere in such families facilitates ego deficits like those of the borderline personality as it molds the child's efforts to avoid anxiety. Devaluation, loss, and defenses against mourning partially account for depression and paranoid traits in abused youngsters. Early neglect and abuse exposes them to influential models who act out rage and primitive defenses. Some abused individuals project their rage and later become paranoid or antisocial, whereas others fragment or retain infantile defenses. The destructiveness of severe psychological abuse lies in the constriction of the experiencing self and healthy character development, together with the conditioning to repeat abusive relationships and to avoid intimacy. Achieving individuation under these circumstances entails overcoming the internalized abusive relationships and relinquishing the unconscious wish to be transformed from the abused into the abuser.     

The real person of the analyst and his role in the process of psychoanalytic cure

This paper focuses on the real relationship with the analyst in the psychoanalytic situation as an aspect of the therapeutic process that leads to change. The role of free association, clarification, and interpretation of the transference are taken for granted as major activities of the analyst, and the real relationship with him is seen as a complementary but important ingredient for change. In particular, his emotional availability determines the climate of analysis. The concepts of neutrality, anonymity, and abstinence, though of importance as guideposts in the conduct of an analysis, have conceptual limitations that not infrequently bind the analyst in a stance that is not useful for the progress of the analysis. On occasion, confirmation by the analyst of the verity of an experience in the patient's early life facilitates the analytic process. This occurs particularly in situations of early trauma, but at times may include chronically traumatic early life experiences. An important motivating force in analysis is the patient's unconscious wish to find the ideal parent absent in early life experience, a wish that is experienced and ultimately analyzed. This is to be distinguished from a defensive idealized transference. Psychoanalytic developmental psychology contributes to our understanding of how the real person of the analyst, his emotional availability, his responsiveness at particular times, his attitude toward action and progressive change in the patient, affect the therapeutic process that leads to change.     

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.     

Grief as a Transcendent Function and Teacher of Spiritual Growth

Death is an inevitable phase of life, so is grief. This paper attempts to pinpoint the enormous potential of grief in advancing our spiritual growth. Jung states that when encountering a crisis such as loss, the unconscious often breaks through to help us with new adjustments, whereby a transcendent function takes place (Jung, 1971). Instead of becoming an emotional trauma, grief can transcend our everyday experiences and awaken us to our spiritual essence.     

Girl Who Wrote to Primo Levi. The “Foreign Body” Speaks

Through the exposition of a clinical case, the author explores how a sexually abused woman can set up strategies for psychic survival to the feeling of catastrophe and how she can attempt to communicate and share it. The clinical case connects childhood sexual abuse trauma and the trauma of surviving concentration camps. The paper refers to two main achievements of Ferenczi’s research: (1) the consequences of the traumatic experience and of the disavowal of it, such as dissociation, fragmentation, psychic agony; and (2) the focus on countertransference as emotional sharing and as receptiveness to the deep, unconscious and unspeakable communications, which can transfer to the psychoanalyst through somatic ways.     

Exploring consciousness in emotional face decoding: an event-related potential analysis

The author analyzed the role of consciousness in emotional face comprehension. The author recorded psychophysiological measures of event-related potentials (ERPs), elicited by supraliminal and subliminal stimuli when participants viewed emotional facial expressions of 4 emotions or neutral stimuli. The author analyzed an ERP emotion-specific effect (N200 peak variation; temporal interval was 180-300 ms poststimulus) in terms of peak amplitude and latency variables. The results indicated 4 important findings. First, there was an emotional-specific ERP deflection only for emotional stimuli, not for neutral stimuli. Second, the unaware information processing was quite similar to that of aware in terms of peak morphology, but not in terms of latency. In fact, unconscious stimulation produced a more delayed peak variation than did conscious stimulation. Third, valence of facial stimulus (positive or negative) was supraliminally and subliminally decoded because it was showed by differences of peak deflection between negative high arousing (fear and anger) and low arousing (happiness, sadness, and neutral) stimuli. Finally, the author found a more posterior distribution of ERP as a function of emotional content of the stimulus. Cortical lateralization (right or left) was not correlated to conscious or unconscious stimulation. The author discussed the functional significance of her results in terms of supraliminal and subliminal conditions.     

Emotional Memory,Metaphor, and Meaning

Advances in neuroscience make it possible to view the construction of meaning as a biological property. Freud's Project for a Scientific Psychology in which emotion and memory form a seamless unified system is seen as an attempt to establish psychoanalysis as a neurobiology of meaning. In the unconscious construction of meaning, metaphor plays a salient role; metaphor is the currency of mind. I have suggested that metaphor functions unconsciously as a pattern detector and thus plays a dominant role in the organizing and categorizing of emotional memory. Consideration of the evolution of the limbic system enables us to make a functional distinction between unconscious emotional memory and conscious feelings. These observations should lead to a revision of our current psychoanalytic theory of affects.     

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.     

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.     

Der Stellvertreter

Based on the analytic work on colleagues the author investigates a writer’s block of German psychoanalysts when writing about their patients. In the process of their own therapeutic analysis, an inhibition of association in these psychoanalysts comes to the fore by them falling into the professional role and talking about their patients. The accounts of these colleagues on their own patients function as a doubled imago revealing the unconscious conflicts of the patients as well as acting as a proxy of the psychoanalysts’ impulses, affects and foreclosed memories in their own analysis. The inhibition of thinking, leading to a writer’s block, is the result of the correspondence of the trauma of the patient with the trauma of the analyst when the transference-countertransference relationship evokes annihilation anxieties in the psychoanalyst. Therefore the writer’s block of these psychoanalysts is rooted in their professional work and is the result of the internalization of precarious emotional contents of their patients. The author examines the role of institutionalized psychoanalysis in developing a professional writer’s block, and the results of the paper highlight the need of an emotionally supporting professional environment for the psychoanalyst during his training and his practice work.     

The divergent effects of fear and disgust on unconscious inhibitory control

Previous studies have shown that negative emotional distracters impair conscious inhibitory control. Recent research has shown that inhibitory control can be triggered unconsciously; therefore, in Experiment 1, we aimed to investigate whether negative emotional distracters affect unconscious inhibitory control. Furthermore, in Experiment 2, we examined whether fearful and disgusting distracters have differential effects on unconscious inhibitory control. Participants were instructed to perform a masked Go/No-Go task superimposed on a negative or neutral image cue (Experiment 1) or on a fearful, disgusting or neutral image cue (Experiment 2). Results showed that negative emotional distracters impaired unconscious inhibitory control; furthermore, disgusting distracters impeded unconscious inhibitory control when compared to fearful ones. This study is the first to provide evidence that fear and disgust may affect unconscious inhibitory control differently. These results expand the understanding of the relationship between emotions and inhibitory control.