The workable here and now and the why of there and then

At an earlier time our work as analysts was easier. We searched for the repressed in order to make constructions that connected the past to the present symptoms. Making these connections conscious, based upon the continuing influence of the Topographic theory, was thought to be the curative factor in psychoanalysis. Freud (1912, 1914) briefly expressed the importance of working in the present but his main focus remained the importance of reconstructing the past. The importance of working in the present started to be fully articulated approximately 30 years ago, and has become a central part of most views on technique. However, it is the contention of this paper that, while there is general agreement on the necessity of working in the here and now, the understanding of what this means or why it is useful runs along parallel lines rather than leading to a central point. Further, it is my impression there is little agreement on the reasons for interpreting the there and then. The idea of a 'workable here and now' is introduced to capture how the here and now might best include the analysand's readiness to synthesize what is offered, while a theory of the necessity for working in the here and now and the there and then is offered.     

'Go! Sterilise the fertile with thy rage' envy as embittered desire

This paper is concerned with the operation of envy: it considers its origins and their repercussions, in particular its compulsion to sterilize the evidence of fertility, exemplified by Roger Money-Kyrle's evocation of 'the parental intercourse as the supremely creative act'. The inevitable impact on the analytic relationship is considered in the context of two clinical examples of impasse. It is argued that such fundamentally negative transferences, one full of overt aggression and enactment, the other more covertly sabotaging, derive from envious retaliatory impulses originating in experiences--whether phantasied or factual--of exclusion from the anticipated 'good'. Significant recent Jungian contributions to this area are considered and the absence of references to 'envy'--so characteristic of Kleinian discourse--is noted. The ongoing value of integrating Jungian and Kleinian approaches is affirmed.     

拯救肢体畸残患者的“菩萨”——秦泗河从事儿麻后遗症矫治30年的纪念

秦泗河医生30年来坚守于基层乡、区级医院,毕生心血奉献于小儿麻痹后遗症——肢体畸残矫治事业,开创了肢残矫治“前无古人,后无来者”的秦泗河畸代,值得珍惜、尊重和纪念,更是为了记住历史,给这样的事业以应有的地位和尊重。其多重意义,将为医学界带来激励和启迪。     

Mentalization, insightfulness, and therapeutic action The importance of mental organization

Continuing debates over the relative importance of the role of interpretation leading to insight versus the relationship with the analyst as contributing to structural change are based on traditional defi nitions of insight as gaining knowledge of unconscious content. This defi nition inevitably privileges verbal interpretation as self‐knowledge becomes equated with understanding the contents of the mind. It is suggested that a way out of this debate is to redefi ne insight as a process, one that is called insightfulness. This term builds on concepts such as mentalization, or theory of mind, and suggests that patients present with diffi culties being able to fully mentalize. Awareness of repudiated content will usually accompany the attainment of insightfulness. But the point of insightfulness is to regain access to inhibited or repudiated mentalization, not to specifi c content, per se. Emphasizing the process of insightfulness integrates the importance of the relationship with the analyst with the facilitation of insightfulness. A variety of interventions help patients gain the capacity to refl ect upon and become aware of the intricate workings of their minds, of which verbal interpretation is only one. For example, often it seems less important to focus on a particular confl ict than to show interest in our patients’ minds. Furthermore, analysands develop insightfulness by becoming interested in and observing our minds in action. Because the mind originates in bodily experience, mental functioning will always fl uctuate between action modes of experiencing and expressing and verbal, symbolic modes. The analyst's role becomes making the patient aware of regressions to action modes, understanding the reasons for doing so, and subordinating this tendency to the verbal, symbolic mode. All mental functions work better and facilitate greater self‐regulation when they work in abstract, symbolic ways. Psychopathology can be understood as failing to develop or losing the symbolic level of organization, either in circumscribed areas or more ubiquitously. And mutative action occurs through helping our patients attain or regain the symbolic level in regard to all mental functions. Such work is best accomplished in the transference. The concept of transference of defense is expanded to all mental structure, so that transference is seen as the interpersonalization of mental structure. That is, patients transfer their mental structure, including their various levels of mentalizing, into the analytic interaction. The analyst observes all levels of the patient's mental functioning and intervenes to raise them to a symbolic one. At times, this will require action interpretations, allowing oneself to be pulled into an enactment with the patient that is then reprocessed at a verbal, symbolic level. Such actions are not corrective emotional experiences but are interpretations and confrontations of the patient's transferred mental organization at a level affectively and cognitively consistent with the level of communication. Nonetheless, the goal becomes raising the communication to a symbolic level as being able to refl ect symbolically on all aspects of one's mind with a minimum of restriction is the greatest guarantee of mental health.     

The profession of ferryman: Considerations on the analyst's internal attitude in consultation and in referral1

Psychoanalytic consultation is an interview with a patient who will not be taken in treatment by the consultant analyst, but who will be sent to another, perhaps specifi cally chosen, colleague after one or more assessment sessions. This practice is becoming increasingly important since, besides traditional private relationships between consultant and patient, it is now common in many specialized centres affi liated to offi cial psychoanalytical institutions. The author explores some fundamental aspects of the analyst's internal attitude in consultation: motivation to know; a ‘concave’ attitude to listening; responsibility in proposing suitable technical choices and referral to a further specialist; empathy and partial identifi cation; the balance between authentic experience in the consultation and risks of seduction; internal links within the community of colleagues; the technique for sending patients on. He presents a clinical example, specifi cally aimed at reproducing the internal attitude of the analyst, together with the necessary work that allows a diffi cult patient to initiate psychoanalytic treatment.     

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.     

Adults who are more anxious and were anxiously attached as children report later first memories

Here, we examined retrospective reports of adults’ earliest autobiographical memory, the age of this report and whether the reported age was associated with exposure to early life adversity, current anxiety and childhood attachment. Across four studies, we found that reporting a later ‘earliest’ memory was associated with higher self-reported anxiety in both American (Studies 1, 2 and 4) and Australian (Study 3) samples. Furthermore, in Studies 2–4, we found that reporting a later earliest memory uniquely predicted anxiety when controlling for number of adverse childhood events (a risk factor for the development of anxiety). In Study 4, we established that this relation is partially mediated by childhood anxious attachment. Although we consistently demonstrated that later earliest memories were associated with current anxiety, we found little evidence for a relation between reported age at the time of earliest memory and childhood adversity. We also found no evidence of gender differences in the associations of interest. These results suggest that poorer memory of early childhood is associated with greater childhood anxious attachment and anxiety in adulthood. The implications of this work are discussed in terms of the adaptive nature of autobiographical memory and the development of a coherent life narrative.     

The work of the psychoanalyst in the field of psychosis1

Psychosis questions the foundations of psychoanalytic theory and challenges our ultimate convictions about psychic functioning. Using her clinical practice, the author explores the foundations of representation and underscores the central position of sensoriality in constituting a representation. Psychoanalytical work with a psychotic subject requires a certain sharing of the psychotic experience which puts the analyst in touch with raw material grasped as a fragment of sensoriality that must consequently be shaped and figured so that the subject's representational activity can resume. The author thus uses the Freudian notion of figuration to specify this ‘raw material’ and its sensory texture. She then refers to Aulagnier's pictograms as a way of thinking about sensoriality under the sign of displeasure and pain rather than pleasure. In the light of this theoretical development, the author re‐examines the opening excerpts from her clinical cases to come up with a practice of interpretation as figuration that allows jointly for the shaping of the raw material and the identifying import of this shaping.     

'The healing power of love': The literary/analytic bond of marriage in Freud's essay on Gradiva

Freud 's declared position regarding the management of 'transference love' advocated 'abstinence', objectivity and even 'emotional coldness in the analyst'. However, his essay on Jensen's Gradiva reveals an identification with an involved and responsive 'maternal' analytic position associated with theorists such as Ferenczi, Balint and Winnicott. These theorists attribute the origins of transference love to the pre-oedipal stage, shaping their analytic model on the basis of the early relationship with the mother. Freud generally had difficulty identifying with such a position, since it entailed addressing his own inner feminine aspects. Yet a literary analysis of his 'Gradiva' reveals this stance in his textual performance, i.e. in the ways in which he reads and retells Jensen's story. Freud 's narration not only expresses identification with Zoe, the female protagonist, but also idealizes her 'therapeutic' conduct, which is closer in spirit to that of object-relations theorists. His subtext even implies, however unintended, that an ideal treatment of transference love culminates in a psychical 'marriage' bond between the analytic couple, a metaphor used by Winnicott to describe the essence of the mother–baby (analyst/patient) bond. Freud 's reading process is itself analogous to Zoe's 'therapeutic' conduct, in that both perform a creative and involved interaction with the text/patient.     

Good vibrations: Analytic process as coupled oscillations

This paper develops a new model for the action of psychoanalysis based on concepts from non-linear dynamics (chaos theory and complexity theory). It shows that the analyst–analysand couple may be conceptualized as a new configuration with its own properties that promote complex development in both members of the couple. These developments are an emergent result of the formation of the analyst–analysand couple and are significantly independent of the particular content of the manifest interaction of the couple. The well-studied phenomena of coupled oscillators suggest the specific features of the analysand–analyst interaction that are likely to be most important in conceptualizing analytic change. The model has substantial clinical applications since efforts to arrange for a coupled oscillator system that is central to it are distinct from many of the traditional considerations associated with creating an analytic situation.