Therapeutic Passion in the Countertransference

The place of the analyst's “influence” in psychoanalytic theory and practice is explored. There is a current in the literature in which it is welcomed as an aspect of “corrective experience,” although usually legitimized by being forced into the narrow channel of interpretation and understanding. A taboo on influence persists despite theoretical shifts that would seem to clear the way for greater acceptance of its importance. Among other factors, the aversion to influence is traced to its association with hypnotic “suggestion,” which implies little room for the patient's autonomy. Opening the door to embracing the possibility of influence goes hand in hand with, on one hand, the analyst respecting the patient as a competent free agent and, on the other hand, the analyst combining willingness to take a stand with willingness to reflect critically on his or her participation. In that context, and with those caveats, the analyst takes on the responsibility to combat destructive introjects and to become an inspiring, affirmative presence in the patient's life. The analyst's passion for the patient's well-being and for changes that entail the realization of dormant potentials now has its place. Different kinds of expression of therapeutic passion in the countertransference are described and illustrated.     

A Model of Infant Mood States and Sandarian Affective Waves

There has been little or no research on the establishment of infant moods or the mechanisms underlying them. One reason may be our difficulty in entertaining the idea that there are affective processes in infants that have long-lasting organizing continuous effects. It is this possibility that is considered in this paper. I attempt to address the questions of how moods are created and what some of their functions are. My model of moods is that infants have long-lasting (e.g., hours, days, and even longer) mood states. Mood states are dynamically changing yet distinct assemblages of affective behaviors. Mood control processes are modified by affective input from others. Thus moods are cocreated by the interplay of active, self-organized, biorhythmic affective control processes in the infant and the effect of the emotions expressed by others on mood control processes. In recognition of the importance of Sander's thinking to this work, I have named one of these processes the Sanderian Affective Wave. Mood states organize behavior and experience over time. Critically, moods serve an anticipatory representational function by providing directionality to an infant's behavior as he “moves” into the future. Thus they provide continuity to infants' experiential life. Furthermore, moods fulfill the Janus principle of bringing the past into the future for the infant, but as a noncognitive/symbolic/linguistic process—that is, as a purely affective–memorial process. Moreover, I believe that consideration of the development of moods opens the way for thinking about dynamic conflictual emotional processes in infants. Lastly, thinking about moods has important implications for understanding the development of pathology and for therapy.     

Response to Layton: Considering the Sociopolitical Context of Dialectical Constructivism

What is commonly missing from psychoanalytic formulations, including my own, that Lynne Layton rightfully challenges us to correct is the locating of the possible dysfunctionality of the individual and the family within the context, not just of a brutally indifferent universe but also of an arguably brutally indifferent economic, political, and institutional environment. I differ with Layton in that I am more prepared to consider possible universals that bear on human experience and moral standards. For example, I would say that “reflection on the foundations of knowledge” trumps nonreflective fundamentalist thinking in capturing the best attitude to assume towards pursuit of truth. Also, the universality of the human tendency to deny death may underlie many diverse cultural belief systems. Nevertheless, Layton challenges us to reflect on how conventional psychoanalytic practices may collude with aspects of our own culture we would do well to try to combat, in ourselves and in our patients, through owning and proactively exercising our moral influence.     

At Death's Door: Therapists and Patients as Agents

This paper explores the interrelationship between patients' exercise of will to make advances in an analysis and their readiness to forgive their analysts for their human limitations. There is a thin line between idealization of the analyst, probably a necessary component of the process, and resentment of the analyst for his or her privileged position in the world and in the analytic situation itself. The patient's “progress” emerges as a kind of reparative gift, one that implicitly overcomes the patient's tendency to withhold such change out a sense of chronic, malignant envy. Particularly poignant in terms of its potential to elicit the patient's reparative concern is the situation in which the analyst is struggling with his or her mortality because of aging or life-threatening illness. In this essay two clinical vignettes are presented to illustrate some of the issues that this situation poses. One begins with an elderly patient appearing at the door of the analyst's (the author's) home the day of his return from the hospital after coronary bypass surgery. The other begins with an analyst who is terminally ill appearing at the door of a patient who is threatening suicide. The two stories are compared in terms of their implications for human agency, the exercise of will, and the coconstruction of meaning in the face of mortality in the analytic process.     

Affect of the unconscious: Visually suppressed angry faces modulate our decisions

Emotional and affective processing imposes itself over cognitive processes and modulates our perception of the surrounding environment. In two experiments, we addressed the issue of whether nonconscious processing of affect can take place even under deep states of unawareness, such as those induced by interocular suppression techniques, and can elicit an affective response that can influence our understanding of the surrounding environment. In Experiment 1, participants judged the likeability of an unfamiliar item—a Chinese character—that was preceded by a face expressing a particular emotion (either happy or angry). The face was rendered invisible through an interocular suppression technique (continuous flash suppression; CFS). In Experiment 2, backward masking (BM), a less robust masking technique, was used to render the facial expressions invisible. We found that despite equivalent phenomenological suppression of the visual primes under CFS and BM, different patterns of affective processing were obtained with the two masking techniques. Under BM, nonconscious affective priming was obtained for both happy and angry invisible facial expressions. However, under CFS, nonconscious affective priming was obtained only for angry facial expressions. We discuss an interpretation of this dissociation between affective processing and visual masking techniques in terms of distinct routes from the retina to the amygdala.     

What drives sleep-dependent memory consolidation: Greater gain or less loss?

When memory is tested after a delay, performance is typically better if the retention interval includes sleep. However, it is unclear what accounts for this well-established effect. It is possible that sleep enhances the retrieval of information, but it is also possible that sleep protects against memory loss that normally occurs during waking activity. We developed a new research approach to investigate these possibilities. Participants learned a list of paired-associate items and were tested on the items after a 12-h interval that included waking or sleep. We analyzed the number of items gained versus the number of items lost across time. The sleep condition showed more items gained and fewer items lost than did the wake condition. Furthermore, the difference between the conditions (favoring sleep) in lost items was greater than the difference in gain, suggesting that loss prevention may primarily account for the effect of sleep on declarative memory consolidation. This finding may serve as an empirical constraint on theories of memory consolidation.     

Book Review

Previous efforts to demonstrate the coping benefits of Muslim beliefs have yielded ambiguous outcomes. With a sample of 200 Pakistani adults, this project used the Islamic Positive Religious Coping and Identification (IPRCI) subscale within the Psychological Measure of Islamic Religiousness (PMIR) to examine relationships with the experience and behaviour of Ramadan. Preliminary confirmatory factor analyses revealed a need to focus on a Positive Islamic Coping factor within the IPRCI. Positive Islamic Coping correlated directly with Positive Ramadan Experience and Ramadan Behaviour and inversely with Negative Ramadan Experience. Along with other PMIR variables assessing Muslim commitments more generally, Positive Islamic Coping helped mediate relationships between Ramadan Experience and Ramadan Behaviour. Punishing Allah Reappraisal from the PMIR displayed only minimal evidence that it recorded a maladaptive form of religious coping. These data confirmed Positive Islamic Coping as an operationalisation of adaptive Muslim coping and illustrated the importance of examining measures that are relevant within a religious tradition.