Precursors to Masochistic and Dependent Character Development

The American Journal of Psychoanalysis -     

Craving,longing, denial,and the dangers of change: clinical manifestations of greed

Greed is the unrelenting and unrealistic search for all the good an object has to offer and, via identification, all the good one can produce and provide. In phantasy, and sometimes in the patient's early developmental environment, the object and the ego demand more from each other than either have to give. Some patients cannot contain their urge to possess all and to be all, so it becomes a part of the interpersonal and psychological relationship with the analyst rather quickly. These patients feel something is owed to them, and they demand to be fed immediately. Other patients try and hide these greedy phantasies by being the opposite of greedy. They strive to be independent and charitable, while having great conflict over deeper desires to be dependent and in possession of an idealized giving object, an all-providing breast. Case material was used to explore these ideas.     

Paranoid-Schizoid Anxiety,Triangulation, and Oedipal Trauma

The interaction of strong aggressive and libidinal drives, various primitive intrapsychic fantasies linking somatic sensations, body parts, ego, object, and the effects of early environmental stress and trauma all produce a potential crisis in the paranoid-schizoid period of development. Certain innate methods of understanding somatic experiences as well as the interaction between internal and external reality lead to an unconscious triangulation of part objects. A frustrating, stimulating, or punitive "third" that blocks, nullifies, or overgratifies certain wishes then emerges as a pivotal object in the internal landscape. During the paranoid-schizoid, triadic process, there is a fluctuation between separation/individuation and de-differentiation/fusion. If the early triangulation process has been either exceedingly frustrating or overly stimulating in regards to "reaching the third" or "warding off the third," the infantile ego is fixed by aggressive and libidinal forces to de-differentiation experiences rather than to more separate and individuated ways of relating. Therefore, the later oedipal stage will be colored by excessive oral and anal conflicts and will be weighted on the side of primitive maneuvering based on splitting, projection, and introjection. When the child (and later the adult) becomes involved in oedipal situations marked by stimulation or frustration of triadic drives, there can be a regression to the earlier paranoid-schizoid triadic period. A case study was presented in which a patient struggled with a partial working through of these conditions in dreams and in the transference. This pulled her more in the direction of a differentiated Oedipal conflict and whole object functioning.     

Object relational disturbances that may underlie the diagnosis of attention-deficit disorder in adults

Extensive case material is used to show how some adult patients who have been diagnosed with and medicated for attention-deficit disorder (ADD) may be actually suffering from underlying unconscious object relational conflicts that interfere with their ego-functioning, creating an inhibition of basic concentration, focus, expression, and learning. Early childhood experiences of trauma and neglect can create destructive patterns of projective identification based paranoia, guilt, and intense anxiety. The author proposes that these patients have to sacrifice their own identity, psychological organization, and ability to learn or teach in order to keep the peace with others. In order to avoid conflict, difference, and uncertainty, these patients do whatever they can to placate, please, and not disturb the object. However, they often end up extremely resentful, oppositional, and passive-aggressive in reaction. The overwhelming anxiety these patients experience in relationship to the object and to their own internalized demanding critic blocks their ability to learn and grow. In addition, new knowledge, mastery, and creativity are seen as dangerous, forced upon them, or bringing unsafe attention to them. So, in defense, they adapt an inert, scattered, or formless way of living to keep under the radar. This paper advocates the psychoanalytic treatment of such internal conflicts over the popular diagnosis of ADD. Difficulties of learning, attention, concentration, and organization can be better understood and treated as a set of core psychological issues open to gradual working through and healing rather than neurological defects that can only be controlled or managed with strong medication and behavioral exercises.     

A Kleinian view of psychoanalytic couples therapy: Part 1

This paper will investigate the central aspects of the psychoanalytic treatment of couples. The concept of analytic contact is introduced and the importance of each party of the couple being witness to the other party's response to analytic contact is discussed. Emphasis will be placed on issues of thinking, projective identification and the concept of container‐contained. Part 1 of the paper will focus mainly on theoretical issues but will then utilize one clinical case to illustrate some of the theoretical points. Using extensive case reports, Part 2 will continue to provide the reader with an in‐depth view of the important process of a couple's therapy within a psychoanalytic framework.     

Interpretive acting-out: Unavoidable and sometimes useful

Abstract

Using one detailed case presentation, this paper examines the clinical hardship of making accurate and helpful interpretations that do not become part of the patient's defensive system. The author argues that interpretive acting-out is inevitable in the psychoanalytic process. But, if properly monitored, understood, and contained, these interpretive enactments can sometimes actually be a profit to the overall treatment. Issues of projective identification, countertransference, and the importance of realizing our transference role in the patient's changing phantasies are discussed throughout the case material.     

Addictions and the Quest to Control the Object

Most patients come into psychoanalytic treatment engaged in some form of repetitive, destructive behavior that is an externalization or projection of their internal struggles. One form of this object relational acting-out is the addictions, be they to alcohol, gambling, drugs, sex, procrastination, or other variations. The patient's experience is a "must do-can't stop" one that leaves them both desperate and relieved. Patients come to us wanting help in refraining from these addictive patterns. Sometimes, they are attending a 12-step program or are in a day treatment recovery program but need additional assistance in remaining free from their addictive behaviors. Others seek out psychoanalytic treatment while still involved in their addiction, but wish to stop the behavior and build a more positive plan for their lives. This paper examines the deeper object relational issues that lie behind the addictive process. The transference is often colored by acting-out, by sadomasochistic dynamics, by projective identification, and by fantasies of persecution and loss. Case material is used to explore these specific problems as well as the patient's general difficulties with paranoid-schizoid and depressive functioning.     

CONTAINING,TRANSLATING, AND INTERPRETIVE ACTING OUT

In analytic treatment, when patients project unspoken aspects of their internal self and object world, the analyst has to find ways to understand and communicate those expelled phantasies without the patient feeling accused, seduced, or persecuted; even when we do our best at interpreting such inner conflicts, the patient may experience our interpretations as assaults, forcing them to give up themselves or their hope for reconnecting with an object. The patient will resist or fight our efforts through the use of projective identification. Caught up in patient's projections, the analyst in turn may enact some of these phantasies by becoming the object rather than translating its presence in the transference, by overemphasizing one side over another of the patient's conflict, or by interpreting accurately but prematurely. These issues are illustrated in two case presentations and discussed in relation to the views of contemporary Kleinian writers on transference and countertransference.     

Stumbling along in the Countertransference: Following Up Enactments with Balanced Therapeutic Interpretations

In the course of a psychoanalytic treatment, many clinical situations create countertransference pulls or invitations to participate in enactments of various degrees. In these projective identification-based transferences, the patient is often successful in drawing the analyst into archaic object relational patterns of acting out. During these moments, the analyst must struggle to find a way to stay therapeutically balanced. The urge to rush to judgment with punitive, seductive, rejecting, controlling, or manipulative comments rationalized as interpretations must be managed. If these unavoidable countertransference enactments are managed and studied, they can provide useful information about the patient's internal struggles and can show the way to making more helpful and more therapeutic interpretations. Case material is used for illustration.