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.     

Confidentiality and paradox: the location of ethical space

Implicit in Jung's alchemical metaphor of the vas bene clausum is the idea of an analytic frame with a space inside it for something vital, a relationship between two selves, to develop. For this to happen, analysts must respect their patients' rights to confidentiality. The paper explores the analyst's state of mind and the intrapsychic processes that are constellated when struggling with ethical dilemmas about issues of confidentiality in analytic work. The author suggests that at times when analysts consider breaking confidentiality, there is often a disturbing inner conflict between their moral principles (codes of ethics) and their internal personal ethical attitude. At these difficult moments, the mutuality of the work and the vas bene clausum can be significantly disrupted. The analyst tries to find a third position, a mental and emotional ethical space where the subjective and the objective, the ethical and the unethical can become more companionable bedfellows.     

Is transference the ‘total situation’?

This paper examines through the detailed explication of analytic material the author's experience of a psychoanalytic and a Jungian way of understanding the interactions between him and his patient. This comparative approach considers where the differences lie with respect to timing and content of interpretations and where the differences are essentially tactical rather than theoretical.     

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.     

DESIRE AND RESPONSIBILITY: THE ETHICS OF COUNTERTRANSFERENCE EXPERIENCE

The analyst's desire expressed in impactful wishes and intentions is foundational to countertransference experience, yet undertheorized in the literature. The “wider” countertransference view, associated with neo‐Kleinian theory, obscures the nature of countertransference and the analyst's contribution to it. A systematic analysis of the logic of desire as an intentional mental state is presented. Racker's (1957) talion law and Lacan's (1992) theory of the dual relation illustrate the problems that obtain with a wholesale embrace of the wider countertransference perspective. The ethical burden placed on the analyst in light of the role played by desire in countertransference is substantial. Lacan's ethics of desire and Benjamin's (2004) concept of the moral third are discussed.     

The clinical revolution of the ‘wise baby’

In an historical context focused on a close examination of the complex relationship between Freud and Ferenczi, the author shows Ferenczi's contribution to the evolution of psychoanalysis. He describes how his ideas and his therapeutic sensitivity anticipated modern clinical thought (for example, Winnicott and Bion), especially the understanding of borderline and narcissistic pathology. The paper considers the following topics: transference and countertransference; early affectivity; the different psychic trauma; phenomena connected with dissociation; the healing factor of the analysis.     

Characterization of Children's Decision Making: Sensitivity to Punishment Frequency,Not Task Complexity

On a gambling task that models real-life decision making, children between ages 7 and 12 perform like patients with bilateral lesions of the ventromedial prefrontal cortex (VMPFC), opting for choices that yield high immediate gains in spite of higher future losses (Crone &; Van der Molen, 2004 Crone, E. A. and Van der Molen, M. W. 2004. Developmental changes in decision-making: Performance on a gambling task previously shown to rely on ventromedial prefrontal cortex. Developmental Neuropsychology, 25(3): 251–279. [PUBMED][INFOTRIEVE][CROSSREF][Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]). The current study set out to characterize developmental changes in decision making by varying task complexity and punishment frequency. Three age groups (7–9 years, 10–12 years, 13–15 years) performed two versions of a computerized variant of the original Iowa gambling task. Task complexity was manipulated by varying the number of choices participants could make. Punishment frequency was manipulated by varying the frequency of delayed punishment. Results showed a developmental increase in the sensitivity to future consequences, which was present only when the punishment was presented infrequently. These results could not be explained by differential sensitivity to task complexity, hypersensitivity to reward, or failure to switch response set after receiving punishment. There was a general pattern of boys outperforming girls by making more advantageous choices over the course of the task. In conclusion, 7–12-year-old children—like VMPFC patients—appear myopic about the future except when the potential for future punishment is high.     

Art, dreams and active imagination: a post-Jungian approach to transference and the image

The term active imagination is sometimes applied rather uncritically to describe all forms of creative activity that take place in depth psychology. Whilst there are many forms of expression that evoke or are evoked by active imagination, they cannot automatically be classed as active imagination. In this article investigation of visualized mental imagery, dreams and art reveals three distinct forms of image-based psychological activity. Integrated and mediated within the transference and countertransference dynamic, it is proposed that the engagement in active imagination reflects and is influenced by the transference. Distinctions between sign and symbol, simple and big dreams as well as diagrammatic and embodied imagery clarify the differences. Examples from clinical practice demonstrate each mode in action within the analytic frame.     

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.