On psychic reality and neutrality: Empathy and the work of construction in countertransference

Abstract

The clinical challenges faced in encountering patients who do not fit the standard treatment of Oedipus conflicts clearly show the limitations of the interpretative method, thus making indispensable the study of clinical concepts and techniques as a way to broaden the psychoanalytic horizons. In order to analyse the different psychopathological problems resistant to traditional clinical approaches, it is necessary to reorganise the technique on the basis of a better understanding of the ways in which subjectivity is rooted in early psychic constitution. In this way, empathy becomes important as a clinical tool. The use of empathy must be understood as a decisive factor in handling clinical cases and situations in which the treatment encounters obstacles that restrict the power of the analyst's verbal interventions.In this case, can we say that the use of empathy interferes directly with and changes the position of the concept of psychic reality? Moreover, as we use empathy, can we also say that the concept of neutrality is transformed, without being abandoned? The intention of this paper is to discuss these questions using clinical material taken from the analysis of borderline clinical cases and situations.     

Projective identification,containment and sojourn in the psyche: Clinical notes on a specific type of transference-countertransference interaction

Abstract

This paper suggests that the interplay between transference and countertransference is considered to be a valuable channel of communication. The author puts an emphasis on the containing function of the analyst. The patient strives for an experience of an object (analyst) that tolerates and copes with the patient's projections. There are some moments when analysts feel themselves to be invaded, controlled or abused by their patient's products. As Bion has postulated, this situation takes the form of a sojourn in the analyst's psyche. Clinical vignettes are given to provide support for the ways in which the analyst contains and elaborates the projections of the patients in his or her own mind and the therapeutic role that these processes have.     

Sexuality and Death (Discussion)

Abstract

The case is presented to show how the fear of death, triggered off by sexuality, is related to the fear of castration. Instead the discussant develops the hypothesis that the fear of death depends on a shift of deep regression towards a primary identification with the figure of the dead father.     

Sandor Ferenczi: A Life Lived Dyadically

The life and theory of Sandor Ferenczi provide insight into both the historic admonition and the dangers of loving feelings in the therapeutic relationship. Ferenczi believed in the creation of mutuality in all analytic dyads. His refusal to subscribe to a hierarchical structuring of the treatment relationship led to his subsequent marginalization from the traditional psychoanalytic canon for nearly a century. On close inspection, however, he was a formative figure who laid much of the groundwork for current thinking about the intersubjective and relational approaches to treatment. Much of his life and theory can be understood through the lens of his relationship with Sigmund Freud. That relationship is closely scrutinized in the following historical examination.     

Seeing and Being Seen: Courage and the Therapist in Cross-Racial Treatment

ABSTRACT

Correction of the patient's distortion is often the focus of therapeutic treatment. However, the therapist's distortions, based upon pre-existing fears, which themselves are often rooted in greater societal issues and energized by the work with the patient (especially as they relate to issues of racial difference between the therapist and patient), can lead to clinical impasse. Just as an effective treatment relies upon the patient's opening up to correcting distortions, so too the therapist must be able to use transference response and become vulnerable to knowing and moving beyond his own fears and distortions.     

Understanding Transference and Countertransference

Abstract

Professional misconduct-especially misconduct involving client-worker boundary violationsgenerates serious costs for clinical social workers. It harms the very clients we aim to help; it frequently tarnishes the reputation of not only the individual social worker involved but also the face of the entire profession; and, it adds significantly to the overall costs of malpractice insurance. This paper defines the scope of the problem and provides support for understanding transference and countertransference as important contributors to prevention.     

The Role of Anxiety Sensitivity and Mindful Attention in Anxiety and Worry About Bodily Sensations Among Adults Living With HIV/AIDS

The current study examined cognitive factors that may be relevant to understanding anxiety and worry about bodily sensations among an HIV/AIDS population. Specifically, this investigation tested the main and interactive effects of anxiety sensitivity and mindful attention on anxious arousal, bodily vigilance, interoceptive fear, and HIV symptom distress among 164 adults with HIV/AIDS. Results indicated that anxiety sensitivity was positively related to anxious arousal, bodily vigilance, and interoceptive fear, but not HIV symptom distress. Mindful attention was negatively related to anxious arousal, interoceptive fear, and HIV symptom distress, but not bodily vigilance. These main effects for anxiety sensitivity and mindful attention were evident after controlling for disease stage, years with HIV, and demographic variables. There were no interactive effects between anxiety sensitivity and mindful attention. Results are discussed in terms of the clinical implications for identifying and treating anxiety and worry about bodily sensations among adults with HIV/AIDS. Limitations of this study include the use of cross-sectional data and self-report assessments.     

Comparing a narcissistic and an autistic retreat: 'looking through or at the window'

In this paper I discuss two different forms of psychic retreats that I encountered in the treatment of a patient who suffered from two traumatic experiences: the loss of his mother when he was 2 years old and his 'near-death' experience when he was five. In the parasitic narcissistic retreat, using intensive projective identification enabled him to create an impasse in the form of a 'high tide - low tide' scenario in which alternating hope and disappointment kept the process going, yet paralyzed development. The autistic retreat, for its part, led to the collapse of projective identification mechanisms, dismantling and disrupting the transference/countertransference negotiations. The emerging state of non-communication and 'near death' seemed to act as a protection against the unbearable pain of abandonment and desolation.     

Clinical implications of The Red Book: Liber Novus

In this presentation I consider whether the importance of Spirit in Liber Novus may render the task of its clinical application peculiarly problematic. Freud's experimentation on himself is briefly compared with Jung's self-experimentation of which Liber Novus is the record. Taking up the theme of the vas from Gaillard's paper, I refer to Jung's two major contributions to the elaboration of the Freudian frame: the necessity for the analyst to have been analysed, and the positive value of countertransference. In an epilogue, I briefly discuss a dream related to the preparation of this report for publication, emphasizing the theme of the disturbing effects of Spirit as a key theme both in Liber Novus itself and in any attempt to assimilate it on the part of the contemporary analyst.     

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.