The Cocreation of Fantasy and the Transformation of Psychic Structure

This author argues that therapeutic action in child psychoanalytic psychotherapy rests with the creation and transformation of fantasy through play, which in turn shifts psychic structure. The paper details the treatment of an eight-year-old girl whose mother's inability to playfully participate in the inner world of her child interfered with the child's development of a fantasy life. The author suggests that the introduction of objective reality (i.e., interpretations that link the child's play with the real world) potentially impinges on and interferes with the transformational processes of fantasy. Developing the capacity to distinguish reality from fantasy does not take place through a forced accommodation to reality, but rather through the expansion of fantasy and a widening of the realm of the imagination. The elaboration of fantasy in concert with a parent or analyst is what builds the child's capacity to differentiate reality from fantasy.     

Book Review: Treating Abused Adolescents,by Eliana Gil,The Guilford Press, 1996, 228 ps

The American Journal of Psychoanalysis -     

On Seeing What Is Not Said: The Concrete Mode of Psychic Functioning and the Development of Symbolization

This paper examines the difficulties that arise with patients who experience a compromised capacity in working on a symbolic level when ensnared in specific transference/countertransference entanglements. In these kinds of situations, patients often operate in what is referred to as the concrete mode of psychic functioning in which there is an inability to think psychologically about their own mind, as well as the minds of others. Similarly, the analyst often has trouble thinking with the patient in processing the actions between them, unable to recruit the patient’s mind in becoming a thinking couple together. Having exhausted conventional technique and interventions in trying to observe the enactment with the patient, the author argues that the analyst’s ability to grab hold of fleeting associations and memories that have not been fully processed not only expands his own mind but also facilitates symbolic functioning in the patient’s mind. By using the imagistic and sensorial substrates of these remembrances to further symbolize personal experiences, the analyst may gain entrée into the patient’s mental life.     

To See or Not to See: Blinded by Guilt: Reply to Commentary

In response to Annabella Bushra's discussion and her focus on what is missing in the clinical material, the author speculates about the repetition of the historical trauma of purifying mixed race in the face of its complexity—trying to neatly package race despite it not so neatly fitting into any one category—and losing the individual by overly focusing on skin color. The author considers the silence, secrecy, and transgression in the treatment and, in this context, a few of Bushra's key points are addressed—sorting out the nature of hate in relation to Susan, passing as transgression, and White guilt. A distinction is made between a malevolent, destructive hate and a loving hate, and White guilt is considered as a defense against recognition of the other.     

Whose Who in the Psychoanalytic Situation: Subject,Object, and Enactment in the Relational and Contemporary Kleinian Traditions

The concept of enactment, although it has probably has become an overused term in the Relational literature, is a relatively new one for the Contemporary Kleinians of London. In explicating and synthesizing these different theoretical perspectives (Relational and Contemporary Kleinians), the author's primary focus is to tackle the notion of subject and object, in the context of enactment. The author first delineates the relationship between reality and fantasy, and each theory's notion of enactment. In doing so, the author shows how these differing theories and their related notion of therapeutic action inform the kind of object the analyst sees himself or herself as. The author also addresses the technical implications related to the consequences that arise for the analyst as an object of the patient's transferences and projections, including how the analyst extricates himself or herself from the enactment. Two previously published vignettes are used for the purpose of comparison. The author argues for a complementary technical stance comprising two analytic modes: analyst as subject and analyst as object.     

A Child Therapist at Work: Playing,Talking, and the Therapist’s Inner Dialogue

The author reflects on his work with a child patient struggling with affect regulation, loss, and his adoption through a detailed process account of the treatment with a focus on the therapist’s inner dialogue in relation to the child’s play and words—how each affects the other. Drawing from his personal use of clinical theory stemming from multiple theoretical influences, the author shows how his associations, identifications, and tentative formulations inform his work and how the various transference/countertransference matrices influence his inner dialogue. Attention is paid to the movement from the therapist as an object within the patient’s closed system to a system that gradually becomes more open, in which the patient is able to take in the therapist’s own person as they come upon various ways to communicate and build a narrative together.     

Fantasies that Light Up Reality: Keeping the “Old Flame” Lit: Reply to Commentaries

In response to Foehl's phenomenological perspective that an underlying unity and interconnectedness does away with the need for any kind of distinction between reality and fantasy, the author argues for maintaining this very distinction. The author then uses his notion of fantasy in revisiting Hirsch's treatment of Angela and makes the case that the absence of desire on the analyst's part and the impasse that persisted is partially a result of not sufficiently reviving, altering, and joining the respective fantasies of analyst and patient that existed in isolation of each other throughout the analysis.     

Mixed Race and the Negotiation of Racialized Selves: Developing the Capacity for Internal Conflict

The author uses contemporary psychoanalytic theory in further understanding the negotiation of conflict and dissociation in biracial patients who are both African-American and White. Drawing on the work of contemporary theorists who have made efforts to navigate the relationship between inner and outer worlds in our understanding of race from a psychoanalytic perspective, the author examines the relationship between race, culture, and internalized self-other relations—how they interact with each other and impact splitting and dissociative processes among self-states. The author argues for a notion of the unconscious as one that contains historical trauma related to race relations that influences the developing capacity to sustain internal conflict between opposing self-states borne out of this trauma. The author shows how society works against the integration of racialized self-states and interferes with the capacity to contain conflict. Through an extended clinical vignette from an analysis of a mixed-race patient, the author looks at the interplay of self-states between a White analyst (author) and a mixed-race patient (African-American and White) as manifested through a series of enactments and the unconscious “mating” between dissociated self-states in both patient and analyst. The author argues that the analyst's engagement of his or her own dissociated self-states and containment of internal conflict is critical to aiding the patient in moving toward greater integration.