The transferential chimera: a clinical approach

The author presents four quite different clinical situations which he believes show the development of an aspect of the transference as a genuinely autonomous psychical neo-reality of the transferential inter-space, which, in the words of Michel de M'Uzan, he calls the transferential chimera. Basing himself on a reading of 'The psychology of the transference', he goes on to propose a more general application of this particular transferential dynamic whose origin lies in matriarchal incest and which develops around the alchemical quaternio of the cross-projective space of the transference-counter transference and in the analytic setting. Finally, he examines the four clinical situations in the light of this application of the transference in order to propound an understanding of his reading, and proposes a hypothesis for the constitution of the transferential chimera out of the intermingling of the de-integrated parts of the self of the analyst and those of the analysand.     

Shifting the focus from what to why

After 4 decades of research on infant behavior and development, the time has come to shift our focus from What infants do to Why they do it when they do—to move beyond the single-minded search for mechanism and to consider the larger question of function. Infants are not merely incomplete adults who simply get better with age, but they are different organisms altogether, perfectly adapted at every point in ontogeny. For this reason, answers to the Why question will necessarily build upon an evolutionary framework that reflects the infant's changing “occupations” or ecological niches. Through this pursuit, infancy researchers will develop a more integrative science and a greater sense of community.     

Female perversion: scenes and strategies in analysis and culture

The author presents some ideas derived from observation in analysis about differing positions of Freud and Jung on perversion and about probable differences in perverse structural elements of women in contrast to men. In general perversion is understood as a defence of the self; in particular with women it is seen as a defensive way of achieving a false wholeness, a pseudo-androgyny. A case study describes the unfolding of a perverted transference. The importance of reaching the analyst and being understood by the analyst through projective identification is stressed. Quite often a sexually abusing mother seems to play an important role in generating female perversion; the implications in analysis are discussed as well as some ideas about culture and gender.     

Has infantile sexuality anything to do with infants?

Classical psychoanalytic theory draws many concepts from mental processes that are assumed to arise in the infant and influence the adult mind. Still, psychoanalytic practice with mothers and infants has been integrated but little within general psychoanalytic theory. One reason is that only few analysts have utilized such practice to further theory. Another reason is that infant therapists tend to abandon classical psychoanalytic concepts in favour of attachment concepts. As a result the concept of infantile sexuality, so central to classical theory, plays an unobtrusive role in clinical discussions on infant therapy. The author argues that infantile sexuality plays an important role in many mother-infant disturbances. To function as a clinical concept, it needs to be delineated from attachment and be understood in the context of mother-infant interaction. Two examples are provided; one where the analyst's infantile sexuality emerged in a comment to the infant. Another is a case of breast-feeding problems with a little boy fretting at the breast. This is interpreted as reflecting the mother's infantile sexual conflicts as well as the boy's emerging internalization of them. Thus, to conceptualize such disorders we need to take into account the infantile sexuality in both mother and baby.     

BECOMING RELATED: THE EDUCATION OF A PSYCHOANALYST

The author uses a “professional memoir,” a story about his first experiences in clinical work, to illustrate what he believes to be certain fundamental aspects of an analytic attitude. Taking place in a psychiatric hospital, it is meant to highlight the central place of intuition, emotional receptivity, empathy, relatedness—and their inherent dangers—in engaging therapeutically with patients' emotional disturbances. The author postulates that these and related aspects of clinical psychoanalysis are not sufficiently emphasized in psychoanalytic training and are often eclipsed by idealizations of psychoanalytic theories and their derivative techniques, third‐party demands for evidence‐based data, preoccupations with neurobiological correlates of experience, etc. Despite the clinical fact that psychoanalysis can be extraordinarily helpful to patients, he questions whether clinical psychoanalysis is rightly regarded as a “treatment.”     

THE PATIENT'S OBJECTS IN THE ANALYST'S MIND

In every analysis, the analyst develops an internal relationship with the patient's objects—that is, the people in the patient's life and mind. Sometimes these figures can inhabit the analyst's mind as a source of data, but at other times, the analyst may feel preoccupied with or even invaded by them. The author presents two clinical cases: one in which the seeming absence of a good object in the patient's mind made the analyst hesitate to proceed with an analysis, and another in which the patient's preoccupation with a “bad” object was shared and mirrored by the analyst's own inner preoccupation with the object. The use and experience of these two objects by the analyst are discussed with particular attention to the countertransference.     

PROBLEMS OF INTERNALIZATION: A BUTTON IS A BUTTON IS—NOT

Analysts hope to help the patient internalize a relationship with the analyst that contrasts with the original archaic object relation. In this paper, the author describes particular difficulties in working with a patient whose defenses and anxieties were bulimic, her movement toward internalization inevitably undone. Several issues are considered: how does the nonsymbolizing patient come to internalize the analyst's understanding, and when this does not hold, what is the nature of the patient's subsequent methods of dispersal? When the patient can maintain connection to the analyst as a good object, even fleetingly, in the depressive position, the possibility of internalization and symbolic communication is increased.     

Lost in translation,found in translation: A case study of working psychodynamically in an interpreter-assisted setting

Effective use of psychotherapeutic treatment in interpreter-assisted settings is well established; however, there has been little discussion of the use of psychodynamically informed treatments in such settings. The literature suggests that therapy facilitated by interpreters is not conducive to psychodynamic approaches due to the presence of a third person, the perceived lack of intimacy, and the difficulties of working with translated material. However, transference, countertransference and other unconscious communications and responses necessarily occur in every therapeutic setting, including triadic therapy using interpreters. This article describes a short-term (12 session) psychodynamically oriented intervention with a 52-year-old Cantonese-speaking man suffering from depression. A female, Chinese-born interpreter assisted in every session. The integral role of supervision in supporting a containing relationship between the therapist and the patient and the difficult emotional responses experienced by the interpreter is highlighted. The article attempts to trace some of the unconscious communications that occurred during the therapy and demonstrates the feasibility of working psychodynamically in an interpreter-assisted setting.     

Freud

The author explores the evidence-base and selection criteria for a short-term supportive dynamic approach for patients whose psychological mindedness and quality of object relationships is low. Illustrating this approach with a case example he outlines the central features of Supportive Dynamic Therapy. He describes a psychodynamic conceptual and developmental framework that can be used to guide the therapist's interventions and responses, and modulate the patient's anxiety. A dynamic focus presented in the form of a central issue is shown to have a significant function both in containing the patient's anxiety, and in giving shape to the therapist's efforts to support the patient's ego-strengths and adaptive abilities. The therapeutic work can be seen to result in an alteration in the trajectory or reiterating pattern of the patient's life.     

The search for evidence: Psychoanalytic practice and the male imaginary

In this paper, I will attempt to discuss the future of psychoanalytic practice in the wake of the National Institute of Health and Clinical Excellence’s (NICE) embrace of ‘evidence’-based practice. In 2005, NICE, whose task is to regulate the provision of health care across the National Health Service, adopted positivistic evidence-based protocols as the sole proof of the effectiveness of psychotherapy. Despite the success over the past 40?years of psychoanalytic and humanistic therapies in primary care and psychotherapy departments of psychiatric hospitals, NICE insists on restricting therapy, to those who can claim effectiveness as a result of using the data from client questionnaires commonly described as ‘outcome measures’ and it has gone on to promoting new modalities many of which have been imported from the States. As a consequence, most of the provision of psychotherapy in the public sector currently, whether as part of the National Health Service or the voluntary sector, has embraced evidence-based practice’ and many training organisations are promoting it, which will, in time, have an effect on private practice. I use some of the threads of the work of the feminist psychoanalyst Irigaray and others to understand this turn to positivistic science and how it can be understood as an instance of the retrenchment of the ‘male imaginary’ and a re-installation of the values of detachment and mastery. I query whether there are some problems within current theory, practice and institutionalisation which interfere with the emergence of a more progressive psychoanalytic practice.