A case study of borderline anxiety andthe process of analytic transformation

Borderline patients present particular treatment problems and require close, devoted understanding of their often chaotic and shifting intrapsychic conflicts. Many of these patients act out, making it difficult to maintain an analytic process. In fact, many terminate early on. When they do stay for longer periods, they exhibit particular constellations of defense, anxiety, and conflict. One extensive case report is used to examine the overlapping cycles of treatment with this population. Frequently, self-destructive acting-out is present in the transference and extratransference. This acting-out is often followed by the self-destructive, antichange attitude of the death instinct. These ways of relating to the self and the object are mobilized within the vehicle of projective identification and are best understood as primitive defenses against core fantasies of loss and persecution. These issues of loss and fear are the final and vital phase of treatment with borderline patients, who are often able to make major fundamental changes in their internal sphere, but only if patient and analyst can tolerate and understand these three levels of intrapsychic experience.     

Out of nothingness: rhythm and the making of words

Abstract: This contribution describes some aspects of the work with a four‐year‐old autistic child who was treated for many years with four times weekly sessions of psychotherapy. The fluctuations between the symbolic and non‐symbolic use of external objects are described, as well as the ever changing quality of the child's object relations. The rhythmical element in the analysand‐analyst interplay is of great importance: the construction of the temporal shapes (Alvarez) and the modulation of presence and absence are relevant as regards the progressive capacity to name aspects of external reality and subjective experience. From a theoretical point of view, the contributions of both the post‐Jungian, including Michael Fordham, and the post‐Kleinian traditions are outlined. The notions of pre‐conception (Bion) and of archetype (Jung) are immensely helpful in working with autistic children as they actually help the analyst in assuming that some proto‐trace of representational potential is always present in the individual.     

Avoiding unbearable pain

This presentation describes the way in which defence mechanisms and resistance manifested themselves in the analysis of a man with a narcissistic personality disorder. In the course of the analysis, there were changes in the forms taken by the defence and the resistance, signalling important genetic and dynamic conditions in his life. Both represented desperate attempts to avoid the unbearably painful feelings and affects which he had experienced in his childhood, and bore witness to early and primitive defence mechanisms such as denial, splitting and projective identification. The defence can also be seen as an expression of an unconscious fear of being re-traumatised. The idealisation of the analyst in the first years of the analysis can therefore be understood as a precondition for entering into this kind of process. It also represented a defence against aggressive and homosexual feelings in the transference which first became clear during the final phase of the analysis and could then be worked through. At this point, the analyst's reactions to his own unconscious countertransference were of help in understanding what was actually going on. This analysis may also suggest that defects and trauma in the earliest years may be conducive to alexithymia, deficient contact between feelings and words, linked to the risk of developing serious psychosomatic illnesses. This may be a consequence of the fact that the child's feelings and affects were neither accepted, understood nor affirmed in words, or they may even have been met with rejection or ridicule. A connection between narcissistic personality disorders and alexithymia can possibly be seen here.     

Making Sense of Walt: A Psychoanalytic Understanding of Racism

This paper explores Klein's concepts of the depressive position, paranoid position, envy, projective identification and reparation, and their application to understanding overt racism. An extensive case example from the movie Gran Torino and its protagonist Walt Kowalski are the foci of this theoretical speculation. Implications for antiracist practice are discussed.     

Mourning the Loss of the Idealized Self: A Transsexual Passage

Abstract

The few published psychoanalytic writings that exist regarding transsexual men and women tend to focus on the etiology of their gender identities and almost invariably define these patients as inherently pathological. Such myopic viewpoints leave no room for analysis and discussion of the transsexual patient's normal developmental process. In this paper, I use a Kleinian framework to depathologize the coping strategies employed by transsexual patients and to illustrate the importance of mourning in the development of a positive transsexual identity. A clinician who is able to sit comfortably with contradiction may facilitate the transsexual patient's mourning process—saying goodbye to the persecutory object of the past and letting go of the idealized image of the future.     

On the immediacy of unconscious truth: understanding Betty Joseph's 'here and now' through comparison with alternative views of it outside of and within Kleinian thinking

Psychoanalysis emphasizes that in discovering psychic truth what is needed is not abstract or distant knowledge of this truth but rather an immediate encounter with it. In this paper the author examines the meaning of this immediacy through the study of Betty Joseph's notion of 'here and now,' which in recent years has been most directly associated with it. The author shows how Joseph's notion of 'here and now' continues a legacy beginning in Freud and taken up by Klein regarding the immediacy of unconscious truth that differs from other available analytic formulations of the term. To highlight the uniqueness of Joseph's contribution the author goes on to examine what distinguishes it within the kleinian framework. She does this in part through comparison with the clinical approach of Hanna Segal, whose focus on unconscious phantasy adheres to the same foundational legacy. The author points to the differences between Joseph and Segal and their significance, which have not been sufficiently elaborated in the analytic literature. She argues that viewing these differences within the context of a shared perspective on the role of unconscious truth in the analytic process and task enriches our understanding of the complexity of kleinian thinking and the meaning of truth in psychoanalysis. This understanding is also furthered by the recognition that many uses of the term 'here and now' in the analytic literature refer to something very different from what Joseph refers to and are based on a perspective that is fundamentally opposed to hers.     

EDUCATION SECTION: Infant observation in Britain:The Tavistock approach

The author draws attention to something distinctive in the psychoanalytic 'air' from the early 1960s onwards: the strong emphasis upon the very early psychological, emotional and cognitive view of infants and young children. She focuses on the work of two analysts in particular, Esther Bick and Wilfred Bion, and the comparable, though differently expressed, centrality of the observational method in their work. Each explored not only the pathological picture but also the nature and integrative function of psychic containment in earliest mental life. Each also shared a preoccupation with what constituted a psychoanalytic attitude and with the process of becoming a psychoanalyst and, in Bick's case, a child analyst or psychotherapist. The author provides an historical background to the idea of observation, followed by an account, with detailed examples, of the nature of infant observation and the observational method as taught and practised at the Tavistock Clinic, London since the late 1940s, and subsequently in many other training institutions. Here the themes of Bick and Bion are constantly interrelated such that the prototype or model for the creation of emotional meaning and thought can be appreciated and learning from experience can take place.     

The universe of our concerns: the human as person in the praxis of analysis

Since its inception, psychoanalysts and analytical psychologists have used the reductionistic methods of science to explain both human development and analytic practice. The most recent iteration of this tendency uses attachment as the explanatory principle. This disposition has created theories that understand the human solely as an organism. While this is a satisfactory way to view human development, it is not appropriate for the practice of analysis. In this context, the human must be viewed as a person that is explicable in his/her own terms. Interpretation based on reductionism eliminates personhood. Humans appear as persons in 'the feeling of what happens' or of 'being there', and, on the basis of this experience, develop stories in which their personhood evolves. The psychoanalytic, philosophical and neuro-scientific basis for this view of the human as person is discussed, and its relevance for analytic practice is considered.     

Psychoanalysis: a dysfunctional family?

The discussion opens with an account of the author's mother's bizarre family in which a strong, charismatic grandmother maintained absolute control over her large family by encouraging a neurotic dependence in them through daily reports of their complaints.
Getting interested in psychoanalysis in an effort to understand the dynamics of this dysfunctional family, the author, a biographer, turned to the study of Melanie Klein, becoming entranced by her ideas. Her research also revealed how Klein had discouraged her followers from developing ideas that diverged in any way from her own. Her portrait of the pioneer analyst provoked intense indignation. A similar pattern of absolute loyalty to his person and theories was to be found in Freud's Secret Committee, formed primarily as a means of getting rid of Jung who had been showing disturbing signs of independence. When Ferenczi and Rank began to pursue independent lines of enquiry in their work, they too were thought to be undermining the foundations of classical psychoanalysis.
Finally, the author concludes that though there have been sorry incidents in psychoanalysis, we should be mature enough to accept both the contributions of the early pioneers and the realizations that new ideas must be permitted to evolve.     

Finite Reasons Without Foundations

This article develops a theory of reasons that has strong similarities to Peter Klein's infinitism. The view it develops, Framework Reasons, upholds Klein's principles of avoiding arbitrariness (PAA) and avoiding circularity (PAC) without requiring an infinite regress of reasons. A view of reasons that holds that the “reason for” relation is constrained by PAA and that PAC can avoid an infinite regress if the “reason for” relation is contextual. Moreover, such a view of reasons can maintain that skepticism is false by the maintaining that there is more to epistemic justification than can be expressed in any reasoning session. One crucial argument for Framework Reasons is that justification depends on a background of plausibility considerations. The final section of the article applies this view of reasons to Michael Bergmann's argument that any nonskeptical epistemology must embrace epistemic circularity.