REPORTING A DREAM ACCOMPANYING AN ENACTMENT IN THE TRANSFERENCE SITUATION

Patients with pathological organisations of the personality present the analyst with considerable technical difficulties. One of these problems arises from the fact that, in such patients, dreams frequently are not being used for communication of unconscious meaning, but instead for purposes of manipulation of the transference situation. They then represent attempts to identify the analyst with a part of the patient's self or with a particular internal object in order to draw him/her into collusive enactments. Following the work of Bion and Segal the paper presents a two-dimensional model in order to clarify the structure and use of dreams in this situation. The model may serve as a background orientation for the analyst in the clinical situation, as is subsequently illustrated in a detailed clinical sequence with a borderline patient. To conclude, the author suggests that whenever tendencies towards acting in are predominant, the interpretation of the enactment should generally be given preference over the interpretation of the dream content. The possible advantages and disadvantages of both strategies of interpretation are discussed. Finally, the author highlights consequences that arise when dealing with countertransference.     

Developing therapist self‐understanding through research

This paper explores the application of reflexive action research in practice by examining a piece of the author's previously published work. A process of inquiry is described that involves reflexively engaging with original formulations in order to further continuing professional development. Guidelines for conducting this kind of research are described.     

Countertransference and the female triangular situation3

This paper represents an attempt toward reconciling contemporary changes in psychoanalytic understandings of female development, particularly in respect to separation issues, with their clinical applications to female patients. Psychoanalytic thinking typically has categorized separation conflicts as pre‐oedipal, but the authors suggest that these are an integral part of the triangular situation of the girl. The authors argue that an allegiance to erroneous theory and/or individual blind spots have led to the infantilization, pre‐oedipalization or cultural stereotyping of females, which constrains the effectiveness of their analyses. The authors present a selected review of the literature on gender‐based countertransference biases in both male and female analysts, with reference to female ‘oedipal’ material. Analytic case material of two women is presented which demonstrates how theoretical misperceptions and countertransferences to triangular separation conflicts can produce an impediment to progression in analysis.     

Miscarriages of psychoanalytic treatment with suicidal patients2

The author describes a particularly perilous frontier on the psychoanalytic landscape‐ namely, the treatment of suicidal patients with serious personality disorders. Using a clinical example of egregious boundary violations by an analyst, he describes specific countertransference pitfalls that lead to mishandling the patients' expressions of suicidal despair. These include disidentification with the aggressor, failure of mentalization, collapse of the analytic play space, reactions to loss in the analyst's personal life, omnipotence, envy of the patient and masochistic surrender. The author emphasizes the unique vulnerabilities that accompany analytic treatment of such patients.     

Journal Reviews

Covington, Coline. 'Learning how to forget – repeating the past as a defence against the present'.
Grotstein, James. 'Bion, the Pariah of O'.
Hinshelwood, R. D. 'The elusive concept of "internal objects" (1934–1943): its role in the formation of the Klein Group'.
Lippmann, Paul. 'On dreams and interpersonal psychoanalysis'.
Renik, Owen. 'Conscious and unconscious use of the self'.
Schaverien, Joy. 'Men who leave too soon: reflections on the erotic transference and countertransference'.
Williams, Gianna, 'Reflections on some dynamics of eating disorders: "no entry" defences and foreign bodies'.
Slavin, Malcolm & Kriegman, D. 'Why the analyst needs to change: towards a theory of conflict, negotiation, and mutual influence in the therapeutic process'.     

The body in analysis: authentic movement and witnessing in analytic practice

This paper will describe a form of active imagination called authentic movement, in which attention is given to the somatic unconscious. In authentic movement, patients are encouraged to focus inward and attend to any bodily sensations, images and feelings which may arise. In the process of focusing inward on one's bodily-felt experience, images, somatic memory and the accompanying feelings which arise are then available to be explored as a communication from the patient's unconscious. Authentic movement supports the individual in linking image with affect in that the individual re-experiences the somatic aspect of symbolization. What was previously conserved on the somatic level as unmentalized experience, can now begin to be taken up into the mind, thought about, and made available for analysis. In authentic movement, the analyst acts as a silent witness to the patient's explorations. The quiet focused attention of the witness helps to create a secure containing environment in which the person moving can experience a sense of feeling held and seen. The function of the witness is to hold the patient's experience in his own mind, particularly what is not yet mentalized. The witness utilizes his somatic countertransference, including any images, feelings and bodily responses which are generated by what is being communicated non-verbally, as a means of understanding and responding to the patient's material.     

Beyond transference,countertransference, the silences and the opinion1

The author examines several works of an intersubjectivist trend, as well as writings by Hanly, Cavell and Bion, defending many of the named psychoanalysts' viewpoints. These viewpoints are expressed in the search and the struggle for truth, recognizing, like Popper, that truth exists but that we cannot know with certainty whether and when we touch upon it, only that this endless effort merits a lifetime's work because it is the attempt at an encounter with ourselves‐the true encounter. The author explains the criticisms by Green of Jacobs, and defends the maintenance of ‘a certain possible neutrality’ (Eizirik). He poses some questions with regard to Ogden's ‘third subject’, considering it, among other aspects, from the supervisory point of view, which may demonstrate the existence of ‘a certain possible objectivity’ of the emotional confl ict. He develops some criticisms concerning silence as an interpretative action by Ogden, and summarizes two case histories. Both were unconsciously attempting to manipulate the analyst intensely‐one of them to get the analyst to intervene in his love life, and the other to interrupt acting out.     

LOVING THE PATIENT AS THE BASIS FOR TREATMENT

The author’s conviction is that a successful treatment is based on feelings of love by the therapist/analyst toward his or her patients. One should differentiate between love that is based on biological erotic-sexual drives and emotional love without erotic biological drive. The treatment process, especially for severely disturbed personalities, should be regarded as a process of new birth and new kind of development. Thus what the patient needs most is a kind of parental “primary love” (according to Balint). This paper presents a full report of a session through which the basic love to the patient is illustrated as enabling the treatment.Yecheskiel Cohen, Ph.D., is a member of the Israeli Psychoanalytic Society and the International Psychoanalytic Association.A version of this paper was presented at a conference of the Israel Psychoanalytic Society, May 2004.     

Social anxiety and fear of bodily sensations in panic disorder and agoraphobia: A matched comparison

This study tests the hypothesis that social anxiety and fear of bodily sensations are associated with the development of agoraphobic avoidance behavior in panic disorder patients. Twenty patients with panic disorder were compared to 20 patients with panic disorder with agoraphobia, matched by sex and duration of disorder. The two groups did not differ on measures of fear and frequency of assertive social responses. However, the agoraphobics scored higher on measures of interpersonal sensitivity, depression, feelings of inadequacy, and hostility. They also reported higher fear of bodily sensations. Although definitive conclusions need to be postponed until prospective studies have been conducted, there is evidence suggesting that the development of agoraphobia in panic patients is associated with hypersensitivity to bodily sensations and interpersonal situations.This research was supported by Grant 560-268-009 of the Dutch Organization for Scientific Research.     

Family Dynamics and AIDS Phobia: A Case Study

The author introduces and defines AIDS phobia. He illustrates the hypochondria type of AIDS phobia from a combined individual, couple, and family treatment perspective. He describes the treatment process and outcome after an effective countertransference-based intervention, connects the individual manifestations of the index patient's illness to the family dynamics, and concludes with an analysis of the multigenerational contributions to the individual's psychopathology.