The day the clock stopped. Primitive states of unintegration,multidimensional working through and the birth of the analytical subject

This paper is based on one idea and built around one clinical experience that helped me to broaden my comprehension of it. The idea, underlying the work of several authors, is that when the analytic field is saturated with primitive and unintegrated mental contents, the analyst’s somatic countertransference is a precious indicator of a deep, dissociated form of communication. The clinical experience concerns the difficult elaboration of a complex, multifaceted countertransference that took place during the early stages of the analysis of a sensitive patient who used to communicate in a very dissociated way and that I found hard to contain. This experience, closely described in the article, led me to formulate the clinical idea that the transference field may be made of distinct layers (psychoid, affective, verbal), and that each one of them may potentially convey dissociated, even contrasting bits of information. The corollary of this is that the analyst should be ready to accept contrasting sensations, feelings and thoughts at the same time, as they might be the basic ingredients of a complex reverie. The analyst could find himself/herself in front of his/her own internal unelaborated multiplicity before a symbolic image may emerge to link the scattered pieces of the experience. Nevertheless, the heart of this paper is not about suggesting an idea, but in the sharing of a complex working through, which fostered the birth of a new, more human relational perspective: the capacity of being together in time, in a transitional space where there is neither total separation nor fusion.     

BE CAREFUL WHAT YOU WISH FOR! THE SURRENDER OF GENDER

Close examination of Freud's Three Essays on the Theory of Sexuality (1905a) reveals an ambiguity in Freud's language as he simultaneously tries to escape 19th‐century psychiatric paradigms concerning sexuality and perversion while also retaining a normative approach to adult sexuality that created new categories of pathology. The result is an ambivalent legacy that has both hampered and helped contemporary clinicians as they deal with a diverse array of presentations of gender and sexual orientation in today's world.     

SEXUAL ABERRATION OR INSTINCTUAL VICISSITUDE? REVISITING FREUD'S “THE SEXUAL ABERRATIONS”

The author reconsiders Freud's “The Sexual Aberrations,” the first of his Three Essays on the Theory of Sexuality (1905), in light of contemporary psychoanalytic theory. Are the concepts of sexual aberration and norm still viable? The author argues that they are necessary but insufficient elements in current theory. He then presents a competing model in which sexuality can be reduced to a more elemental level of disturbance and wish, where it is an expression of a nonsexual wish—for example, to possess or control the object to eliminate separateness. The author presents clinical material to demonstrate this alternative model.     

Personality Types and Development of Adolescents' Conflict with Friends

This study examined the development of adolescents' conflict frequency and conflict resolution with their best friends, and tested whether adolescents with different personality types differed in these developmental changes from early to middle adolescence. Dutch adolescents (N = 922, 468 boys; M_age = 12.4 years at first wave) annually filled in questionnaires for five consecutive years. Growth modelling revealed that, whereas adolescents' conflict frequency and hostile conflict resolution did not change, positive problem solving, withdrawal, and compliance during conflict with best friends increased from age 12 to 16 years. Adolescents with different personality types differed in the mean levels of conflict frequency and conflict resolution strategies. That is, resilients had less conflict with friends than undercontrollers and overcontrollers. During conflict, resilients used the least hostile conflict resolution and compliance, and employed the most positive problem solving. Undercontrollers adopted the least positive problem solving, and overcontrollers complied and withdrew the most. Using a person‐centred approach, three developmental conflict resolution types were identified based on different constellations of the four conflict resolution strategies over time. Adolescents with different personality types had different distributions on the conflict resolution types. Copyright © 2013 John Wiley & Sons, Ltd.     

肺微小浸润腺癌及浸润前病变HRCT影像特征

为总结肺微小浸润腺癌(MIA)、原位腺癌(AIS)及不典型腺瘤样增生(AAH)结节的HRCT影像特征,回顾性收集43例术前2周内行HRCT检查、经胸腔镜切除、组织病理学证实的50个肺结节,分析结节大小、成分及内部特征.结果显示所有AAH表现为纯磨玻璃结节(pGGN),且≤1.0cm,空气支气管征未见,空泡征少见;86％AIS表现为pGGN,71％的AIS≤1.0cm,且空泡征常见(相对于AAH);95％的MIA表现为混合磨玻璃结节(mGGN),其余为实性结节,90％的MIA＞1.0cm,空气支气管征常见(相对于AIS).因此结节的大小、成分、空泡征及空气支气管征在一定程度上有助于MIA、AIS及AAH的鉴别.     

THE ANALYST'S WAY OF BEING: RECOGNIZING SEPARABLE SUBJECTIVITIES AND THE PENDULUM'S SWING

Whether the analyst finds the patient's emerging transference affectively tolerable or intolerable plays an important role in the analytic couple's negotiation of the configuration that the transference‐countertransference relationship ultimately assumes. If the analyst is deeply repelled by transference‐related roles to which he is assigned, patient‐ascribed attributions, or projection‐drenched interactions, he may react in violent protest, engaging in enactments that say more about his separable subjectivity than about the intersubjective situation. While there has been a recent trend to view enactments as a crucial aspect of psychoanalytic technique, this trend risks overlooking the way in which the analyst's way of being comes into play in the treatment.     

Delving into the ‘emotional storms’: A thematic analysis of psychoanalysts’ initial consultation reports

Psychoanalysts’ written reports on initial consultations are a window into the complexities of a crucial aspect of psychoanalytic work. However, systematic research in this area has largely focused on patients’ demographic factors or standardized measures. The present study looked at reports of all the consultations taking place at the London Clinic of Psychoanalysis over one calendar year (N = 100). The aim was to explore psychoanalysts’ different explicit styles of working and reporting as well as further understanding implicit processes used in thinking and writing about each particular consultation experience. A thematic analysis revealed a set of themes that related to a style of working and thinking about the consultation process as a dyadic experience, where the interaction, affective reactions and contact made between the two are the focus when thinking of making a recommendation for psychoanalysis. The majority of the reports had an open, exploratory quality. The writing of reports appears to give the analyst an opportunity to process the consultation experience and arrive at a more triangular position. Writing reports is a more valuable part of the consultation process than has formally been recognized and acknowledged. The limitations of this study as well as the relevance of these findings for future research are discussed.     

Sandplay therapy with couples within the framework of analytical psychology

Sandplay therapy with couples is discussed within an analytical framework. Guidelines are proposed as a means of developing this relatively new area within sandplay therapy, and as a platform to open a wider discussion to bring together sandplay therapy and couple therapy. Examples of sand trays created during couple therapy are also presented to illustrate the transformations during the therapeutic process.     

Emotional reality: A further contribution to dramatology

This paper is a further contribution to dramatology, introduced in this journal in 2009. It focuses on the two basic modes of communication in any dramatic situation: (1) the nonverbal transfer of feelings and emotions, originating in the preverbal period of the love relationship between mother and child, and (2) the interchange of words and thoughts that develops with the acquisition of language. The early nonverbal mode of communication is the basis for proposing to rename Freud's concept of psychic reality “emotional reality.” On this view, emotional reality is seen as the primary fact of psychological life versus thoughts expressed in words as the derivative fact. Developmentally, emotions and ideas become united in complexes combining the emotional coloration of ideas and the ideational content of emotions. From the perspective of methodology, Freud, his followers, and his critics all conflated theories of disorder and theories of treatment. At the beginning of his journey, Freud was dyadic and interpersonal in formulating a unified theory of disorder and a method of treatment. In later years, he formulated monadic and intrapersonal theories of disorder while remaining interpersonal in his method of treatment, contributing to conflicts among the various psychoanalytic schools.     

‘You were not born here,so you are classless,you are free!’ Social class and cultural complex in analysis

The unconscious impact of differences in culture and social class is discussed from the perspective of an analyst practising in London whose ‘foreign accent’ prevents patients from placing her within the social stratifications by which they feel confined. Because she is seen by them as an analyst from both ‘inside’ and ‘outside’ the British psycho‐social fabric and cultural complex, this opens a space in the transference that enables fuller exploration of the impact of the British social class system on patients’ experience of themselves and their world. The paper considers this impact as a trans‐generational trauma of living in a society of sharp socio‐economic divisions based on material property. This is illustrated with the example of a patient who, at the point of moving towards the career to which he aspired, was unable to separate a sense of personal identity from the social class he so desperately wanted to leave behind and walk the long avenue of individuation. The dearth of literature on the subject of class is considered, and the paper concludes that not enough attention is given to class identification in training.