‘Telepathic’ phenomena and separation anxiety

By discussing a treatment characterized by its difficult ending, the author strives to show the dynamic impact of separation on phenomena that can be seen as ‘telepathic’. Led to develop some inalienable attachment to her analyst in the primary transference, the analysand found herself caught up in the contradiction of her visceral dread of dependency, which compelled her to interrupt the work in progress. She then began to work out her analyst's comings and goings and to run into him in public places, as if to be assured of his immovability. This phenomenon arose with high frequency as the effect of some idealization of the maternal object aiming to deny the spatiotemporal gap. The chance that the experience of rejection via indifference may be repeated also entailed the transferential unfurling of a fantasy involving a double, undifferentiation counterbalancing the lived experience of separation. Furthermore, a ‘telepathic’ dream occurred as confirmation of this twin relationship which illustrates the analysand's refusal to renounce her narcissistic object. Projective identifications, agglutinated ego nuclei along with primitive cross‐identifications could, among other concepts, account for such phenomena which are projective in nature yet real all the same. Such mechanisms could have the power to relay thoughts the moment undifferentiated parts of the ego – if not unborn parts of the self – were activated in a potentially symbiotic zone. Marked by a feeling of dispossession, the analyst's countertransference not only seemed to underscore this hypothesis, it also gave a partial explanation for it. Until the analyst could recognize his own nostalgia for a symbiotic relationship, he had to encourage the occurrence of those unexpected meetings which stemmed from a convergence between the transference and the countertransference.     

HYPOCHONDRIA: A REVIEW OF ITS PLACE IN PSYCHOANALYTIC THEORY

After identifying Freud's fundamental contributions to the concept of hypochondria, the author undertakes a brief review of the term's trajectory within the Anglophone and Francophone psychoanalytic literature. Notions of defense, anxiety, and representation as they relate to corporeal experience are discussed. The author illustrates these main axes with which to read hypochondria with clinical material drawn from the analysis of a woman in whom somatic manifestations were especially pervasive.     

The analytic situation as a dynamic field. 1969

This paper discusses the consequences of the importance that recent ³ papers assign to the countertransference. When the latter acquires a theoretical and technical value equal to that of the transference, the analytic situation is configured as a dynamic bi‐personal field, and the phenomena occurring in it need to be formulated in bi‐personal terms. First, the field of the analytic situation is described, in its spatial, temporal and functional structure, and its triangular character (the present–absent third party in the bi‐personal field) is underlined. Then, the ambiguity of this field is emphasized, with special weight given to its bodily aspect (the bodily experiences of the analyst and the patient being particularly revealing of the unconscious situation in the field). The different dynamic structures or lines of orientation of the field are examined: the analytic contract, the configuration of the manifest material, the unconscious configuration – the unconscious bi‐personal phantasy manifesting itself in an interpretable point of urgency – that produces the structure of the field and its modifications. The authors describe the characteristics of this unconscious couple phantasy: its mobility and lack of definition, the importance of the phenomena of projective and introjective identification in its structuring. The authors go on to study the functioning of this field, which oscillates between mobilisation and stagnation, integration and splitting. Special reference is made to the concept of the split off unconscious ‘bastion’ as an extremely important technical problem. The analyst’s work is described as allowing oneself to be partially involved in the transference–countertransference micro‐neurosis or micro‐psychosis, and interpretation as a means of simultaneous recovery of parts of the analyst and the patient involved in the field. Finally, the authors describe the bi‐personal aspect of the act of insight that we experience in the analytic process.     

The logic of turmoil: some epistemological and clinical considerations on emotional experience and the infinite

The idea of the infinite has its origins in the very beginnings of western philosophy and was developed significantly by modern philosophers such as Galileo and Leibniz. Freud discovered the Unconscious which does not respect the laws of classical logic, flouting its fundamental principle of non-contradiction. This opened the way to a new epistemology in which classical logic coexists with an aberrant logic of infinite affects. Matte Blanco reorganized this Freudian revolution in logic and introduced the concept of bi-logic, which is an intermingling of symmetric and Aristotelic logics. The authors explore some epistemological and clinical aspects of the functioning of the deep unconscious where the emergence of infinity threatens to overwhelm the containing function of thought, connecting this topic to some of Bion's propositions. They then suggest that bodily experiences can be considered a prime source of the logic of turmoil, and link a psychoanalytic consideration of the infinite to the mind-body relation. Emotional catastrophe is seen both as a defect-a breakdown of the unfolding function which translates unconscious material into conscious experience-and as the consequence of affective bodily pressures. These pressures function in turn as symmetrizing or infinitizing operators. Two clinical vignettes are presented to exemplify the hypotheses.     

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.     

All holes are the same: Emerging from the confusion

The author describes a type of mental development in which the primitive libidinal value of faeces and urine is kept unaltered all through adulthood. In this instance, individuals harbour fantasies of projective identifi cation with the internal parents, denying their real dependence, which leads to a pseudomaturity. These fantasies are usually accompanied by anal and genital masturbation and have intense aggressive content. Furthermore, there is a signifi cant confusion among all body orifi ces, leading to an inability to distinguish the self from the object, the inner world from outside reality. Individuals with this type of development can only maintain limited object relations and have highly erotized excretory activities. Manipulation of faeces may occur. This structure works as a defence against breakdown, but may also provide pleasure as it gives the illusion of omnipotent control of the object, as typical in pathological organizations. The author presents clinical material and discusses the diffi culties of the analysis, in which the patient tries to seduce the analyst into colluding with his mental functioning, primarily as a means of communication as well as a projection of his despair and his disbelief in the analyst's ability to help him.     

Who speaks? Who looks? Who feels? Point of view in autobiographical narratives1

In this paper, the author aims to substantiate Freud's claim that neurotic illness creates gaps in autobiographical narratives in terms of the narrator's stating and inducing perspectives. He sketches out the role of narrative perspective and the joint taking of a shared perspective by analyst and patient in psychoanalytic therapy. He introduces four ways of representing perspectives in narratives. Three degrees of narrative distortion are exemplifi ed by three excerpts from life narratives and explored in terms of narrative perspective representation. The most comprehensive perspective representation is achieved in the fi rst example by explicitly stating the present perspective of the narrator as well as the past perspective of the story's protagonist by use of mental verbs. In the second narrative, exclusive use of linguistic forms for inducing the protagonist's perspective both overwhelms the narrator and gives the listener an incomplete picture of what happened. Inconsistent motives, denial of responsibility and omission of detail render the third narrative even more diffi cult to follow. The author discusses the clinical signifi cance of this exploratory analysis of perspectives in narratives in terms of claiming responsibility for one's past action and of level of defence mechanisms, and by highlighting the emotional impact on listeners, which the author suggests is the stronger the more perspectives are left out. He discusses analogies to countertransference. The analysis of narrative perspectives offers an approach for systematic research in psychoanalytic practice.     

‘The newspaper reader’: On the meaning of concrete objects in a psychoanalytic treatment1

The author investigates the meaning of concrete objects in the psychoanalytic treatment of a severely disturbed patient for the development of his inner world and the analytic process. She includes a survey of relevant theoretical concepts with an emphasis on Winnicott and Bion. It is shown that the objects served basic defensive functions both within the analytic relationship and for the precarious intrapsychic state of the patient. The author describes the technical dealing that led to a structural change. From the comparison of the initial dream and a later dream, Mr N's inner development from total inclusion in the object to triadic reality of separated, repaired objects becomes discernible. The author shows how this progress was facilitated by his use of concrete objects as links between his psychotic and non‐psychotic parts, as well as by the specifi c way the analyst handled the paradoxical transference‐ countertransference. She also illustrates the thesis that the developmental steps described are crucial for the capability to digest psychic pain by symbolization instead of discharging it in a destructive‐violent way.     

Creating analysts, creating analytic patients

This paper applies a contemporary, 'two-track'- transformational as well as archaeological - perspective on psychoanalytic process to clinical issues in the creation of analytic patients: case finding, recommending analysis, and recommending and negotiating the intensification of frequency of sessions in analytic psychotherapy. Central importance is assigned to the role of the mind and analytic identity of the analyst, including the analyst's capacity to maintain an internal analytic frame and analyzing attitude from the very first contact with the patient and throughout the treatment, the analyst's confidence in and conviction about the usefulness of analysis for a given analytic dyad and the role of the analyst's theory, which must be broad and consistent enough to allow the analyst to feel that he or she is operating analytically when addressing non-neurotic (unrepresented and weakly represented mental states) as well as neurotic structures.     

Teaching medical staff psychological concepts via a hospital newsletter

Despite the increased recognition of the critical role of social and psychological factors in health and illness, the teaching of psychology is rarely integrated in medical education. Staff generally have minimal formal training in psychological concepts. Patients on the inpatient rehabilitation unit frequently present with unexpected reactions in response to acute trauma and resulting changes in identity and capabilities. Rehabilitation goals therefore, must be based on psychological, as well as physical, capacities. A one-page, user-friendly newsletter was designed to illustrate basic psychological principles via case vignettes. The topics of fear, countertransference, and resistance were selected as critical issues staff frequently encounter in their work with patients. The newsletters provided the staff with basic conceptual tools for effectively treating patients, and the work of psychologists was demystified. The newsletter format is proposed as a creative adjunct to didactic teaching.Copies of the newsletter Insight can be obtained by request from Dr. Gold.