Self‐analysis and the development of an interpretation

In spite of the fact that Freud's self‐analysis was at the centre of so many of his discoveries, self‐analysis remains a complex, controversial and elusive exercise. While self‐analysis is often seen as emerging at the end of an analysis and then used as a criteria in assessing the suitability for termination, I try to attend to the patient's resistance to self‐analysis throughout an analysis. I take the view that the development of the patient's capacity for self‐analysis within the analytic session contributes to the patient's growth and their creative and independent thinking during the analysis, which prepares him or her for a fuller life after the formal analysis ends. The model I will present is based on an over lapping of the patient's and the analyst's self‐analysis, with recognition and use of the analyst's counter‐transference. My focus is on the analyst's self‐analysis that is in response to a particular crisis of not knowing, which results in feeling intellectually and emotionally stuck. This paper is not a case study, but a brief look at the process I went through to arrive at a particular interpretation with a particular patient during a particular session. I will concentrate on resistances in which both patient and analyst initially rely upon what is consciously known.     

AFFECT,SYMPTOM, FANTASY,DREAM: CLINICAL AND THEORETICAL CONSIDERATIONS

A symptom being studied in the process of analysis can be seen as not unlike the unconscious affect it sprang from. The author presents a case in which a symptom, premature ejaculation, was analogous to the unconscious affect of guilt, which itself seemed to be a premature defensive transformation of a deeper current of anger. Guilt was interpreted as if it were a psychic premature ejaculation, a defensive derailment of anger. Fantasy and dream seemed to be engaged in similar transformations, with a fantasy of “premature incarceration” not unlike the symptom itself in its analogous functioning. Analysis of affect, symptom, fantasy, and dream in complex, integrative analytic process led not only to resolution of the symptom itself, but also to a deeper understanding of the mind's complex functioning in general.     

Working with and ‘seeing through’ the sexual transference in the psychotherapy of an adolescent boy

This paper explores the challenges and developmental opportunities of working with the sexual transference in psychotherapy with adolescents. Psychoanalytic contributions investigating the nature of adolescent sexuality and the developmental move from a narcissistic organisation to a capacity to form intimate relationships are reviewed, and the question of what happens when there is a lack of containment in infancy is addressed. The way in which unintegrated sexual impulses and phantasies can invade the therapeutic relationship is further discussed through the account of the weekly psychotherapy of a 16-year-old boy who formed a powerful sexual transference to his female therapist. The paper highlights how working through the sexual transference enabled this young man to face his developmental paralysis and begin to use the therapy as an opportunity for psychic growth.     

Boarding school: the trauma of the 'privileged' child

Sending young children to boarding school may be considered a particularly British form of child abuse and social control. The trauma of the rupture with home may be followed by other ordeals such as emotional deprivation and, in extreme cases, physical and sexual abuse. The taboo on expressing emotion, which is common in such institutions, may lead to an encapsulation of the self. Consequently, the needs of the distressed child/self remain active, but unconscious, within the adult. This maybe disguised by an armoured, and very often socially successful, persona. The psychological interplay, between these two facets of the personality, may be detrimental to intimate relationships. In clinical practice the emotional conflict between a desire for intimacy and anticipated exile comes to the fore. Three examples demonstrate how within the transference this may lead to a dependent and erotic atmosphere, which abruptly changes to sever all connection. Changes in the frame, breaks in analysis, and confessions of emotional need are all points at which vigilance is required if such disturbance in analysis is not to end in its abrupt termination.     

A Spinozan lens onto the confusions of borderline relations

In this paper the author describes how, in his analytic work with difficult personality disorders, he uses a neo-Spinozan position or attitude of alpha-thinking and functioning to understand, clarify, and so to manage confused and confusing psychosomatic 'body-mind' and emotional relations, both internally and inter-personally. Two case examples are given, followed by reflections on technique and on the limits of mourning, transformation and irony. The author suggests that a private, ideational double-aspect, mind-body position may be helpful in working with these analysands. This analytic mode may create a radically different understanding by incorporating a relational system of containment, self-containment, observation and memory. In addition, the author gives his own version of the aetiology and dynamics of borderline states and relations, and weaves the two cases he reports on into reflections on his countertransferential responses, reactions, inter-actions and 'reverie' through the lens of a neo-Spinozan conceptual system.     

The week the couch arrived

Changes in the therapeutic environment can elicit intense and unpredictable responses from patients, who then react to the new elements with their own unique thoughts, fantasies, emotions and behaviours. When the change is very specific, and when it entails implications for the treatment itself, these patient responses can coalesce around more profound experiences of the transference as well as of the countertransference. The author, as a candidate or analyst-in-training, purchased an analytic couch for his office and observed the unfolding of what this new couch meant for existing treatments. Using clinical examples, he describes the three most common patient responses that occurred: rejecting, ambivalent, and embracing. The richly variant ideas and fantasies related to the analytic couch are described, and the couch's history within Freudian and Jungian contexts is reviewed. Personal determinants that could lead to the decision of whether to use a couch as part of analysis are considered from the standpoint of the analyst's preferences and own experience with the couch. The couch is discussed as a signifier of the analytic process with cultural meanings alluding not only to familiar stereotypes, but also to psychological healing and self-development.     

Contemporary transference work and the analytic attitude: aims and methods--a clinical workshop

There are various ways of working as an analyst, and there are various ways of utilizing the concept and the phenomena of transference‐countertransference. I hope to draw an adequate picture of a way of working that is called ‘working‐in‐the‐transference’ as distinct from ways of working that ‘analyse transference’. The former has long been practised by many Jungians as well as by many psychoanalysts. As a method, it has aroused controversy in both groups, and is frequently both misunderstood and imitated. It can arouse strong anxiety. It can appear narrow and restrictive. It famously precludes a gamut of activities in which many analysts engage. Is working‐in‐the‐transference old fashioned, or does it deserve to be increasingly appreciated? Can it offer support and validation whilst remaining true to its conception? It was hoped that these questions would be addressed in the clinical material brought to the workshop. The emphasis in the workshop was on active participation and it was hoped that those attending would bring their clinical concerns for discussion.     

A transitory homosexual passion in the course of an analytic treatment1

Do homosexualities express a sexual confl ict originating in bisexuality or must we look for their deep determinism in the narcissistic confl ict and its vicissitudes? Two clinical sequences from the treatment of a borderline patient, which occurred during years seven and eight of treatment, a period characterised by intense drive turbulence and the unexpected occurrence of a transitory homosexual passion, will enable the reader to follow the psychical movements and evolution of the work of representation. The fi rst sequence throws light on the links between her sudden involvement in this homosexual passion and the traumatic dangers of a breakdown of her ego's capacity for representation, linked to a reactivation in the transference of early and later traumatic traces whose reverberation in the transfero/countertransference dynamic was the source of a painful transference that was responsible for this lateral transference movement. The second sequence shows the links between the strengthening of her capacity for representation, thanks to the working through of the oedipal confl ict in its two aspects, and her renunciation of this passion. The roots of this transitory homosexual passion in the deep fl aws of her psychical functioning raise metapsychological questions concerning, in particular, the dynamic of the ‘double’(‘twin’) and narcissism.     

Analysis of transference: A North American perspective

Using detailed clinical vignettes, the author illustrates and compares several North American approaches to the analysis of transference, tracing their origins in Freud's works and in various post-Freudian conceptualizations, including the writings of Anna Freud and Charles Brenner. Particular attention is paid to the work of Merton Gill, Evelyne Schwaber, Paul Gray, and the British analyst, Betty Joseph. Discussed and illustrated are controversies over the broader and narrower views of transference, the interpretation of action in the analytic setting, earlier and later interpretations of transference with particular emphasis on the contrast between contemporary Kleinian and ego psychological perspectives, the role of extra-transference interpretation, and the concept of the transference neurosis. An argument is made for an integrative approach, drawing upon different emphases, depending on the clinical circumstances and the point of affective immediacy for the patient, which may or may not coincide with the point of affective immediacy for the analyst.     

Listening to the Nos

In Re-Calling Ministry (1999), James E. Dittes offers a collection of fourteen poetic essays on the predictable crises of Christian ministry, which he treats not as impediments but as boons to that ministry. A student of Dittes' at Yale Divinity School in the 1970's, I reflect on the truth-telling of my former teacher through the lens of my own twenty years in parish ministry.