Preconscious defence analysis, memory and structural change

Beginning with the ways in which the use of the couch lends 'depth to the surface' (Erikson, 1954), I explore the topography of the inter - and intra subjective psychoanalytic situation and process. I suggest that defences are not by definition unconscious but rather can be observed operating at conscious and preconscious levels, particularly under these conditions. A focus on preconscious disavowal provides a window on what has become unconscious repression. As a result of eliciting and then verbalising the operation of such defences with regard to anxieties in the here-and-now transference, declarative memories of increasingly specific childhood fantasies and events begin to hold sway over unmanageable procedural remnants from the analysand's past. With this may even come the possibility of neuronal regeneration, the more generalisable enhancement of declarative and symbolic functions and the sense of identity with which these are associated. Herein may lie one enduring therapeutic effect of the 'talking cure' - putting feelings into words - as one among a variety of psychotherapeutic modalities.     

The hippocampus facilitates integration within a symbolic field

This paper attempts to elaborate a fundamental brain mechanism involved in the creation and maintenance of symbolic fields of thought. It will integrate theories of psychic spaces as explored by Donald Winnicott and Wilfred Bion with the neuroscientific examinations of those with bilateral hippocampal injury to show how evidence from both disciplines sheds important light on this aspect of mind. Possibly originating as a way of maintaining an oriented, first person psychic map, this capacity allows individuals a dynamic narrative access to a realm of layered elements and their connections. If the proposed hypothesis is correct, the hippocampus facilitates the integration of this symbolic field of mind, where narrative forms of thinking, creativity, memory, and dreaming are intertwined. Without the hippocampus, there is an inability to engage many typical forms of thought itself. Also, noting the ways these individuals are not impaired supports theories about other faculties of mind, providing insight into their possible roles within human thought. The evidence of different systems working in conjunction with the symbolic field provides tantalizing clues about these fundamental mechanisms of brain and mind that are normally seamlessly integrated, and hints at future areas of clinical and laboratory research, both within neuroscience and psychoanalysis.     

Traumatic effects of political repression in Chile: A clinical experience1

The author examines psychic trauma resulting from human rights violations in Chile. Starting from trauma theories developed by authors such as Ferenczi, Winnicott and Stolorow, she posits the relevance of the subject's emotionally signifi cant environment in the production of the traumatic experience. She describes the characteristics of the therapeutic process on the basis of a clinical case. She emphasizes the need to recognize the damage that may be produced within the reliable link between patient and analyst, pointing out the risk of retraumatization if analysts distance themselves and apply ‘technique’ rigorously, leaving out their own subjective assessments. Therapists must maintain their focus on the conjunction of the patient's intersubjective context and inner psychic world both when exploring the origin of the trauma and when insight is produced. The author posits repetition in the transference as an attempt at reparation, at fi nding the expected response from the analyst that will help patients assemble the fragments of their history and achieve, as Winnicott would put it, a feeling of continuity in the experience of being.     

The language of absence

This paper will focus on the concept of 'absence', which describes a continuum of non-responsiveness and misattunement of the environment in the stage of absolute dependence; it refers to concepts like lack, failure, non-recognition, impingement, neglect, tantalizing, ranging to mental, physical and sexual abuse. An extreme external absence causes shock and fear. The automatic survival response is an inner absence, an intrapsychic absence, a dissociation of parts of the self. The external and the inner absence are the negative image of each other. The concept of absence points to the synchronicity of outer and inner reality and portrays the non-responded-to needs of the self. This point of view of the development of psychopathology of the self on the basis of massive dissociation is inherently an intersubjective-field-theory. As the inner absence is created as a reaction to an absence of the other, in analysis - the analyst has an active role in reviving it. This paper will explore the language of absence, that is, the derivatives and consequences of these situations in the inner realm, and in the relations with the analyst. It is the author's contention that understanding and speaking this language has important clinical and technical implications. Understanding the language of absence enables the analyst to recognize its intersubjective and its intrapsychic presence, to provide an environment that allows for its revival, and to facilitate and regulate the annihilation anxiety that awakens when dissociated self-states are experienced. When the absence is present, i.e. when the traumatic experience and the dissociated reactions to it are experienced in an attuned relationship, it is rendered with meaning, symbolization, and validation, and enables the survival mode of dissociation to be relinquished.     

Transferences Toward the Co-Therapist Couple: Triadic Relationships and Selfobject Needs

This paper examines transferences toward the male/female co-therapists within a developmental context, using concepts from self psychology, intersubjectivity, and infant research. In addition, it proposes that some individuals have selfobject needs specifically related to the parental unit, so triadic relationships can influence one's development. Clinical examples elucidate the repetitive and selfobject dimensions of the transferences within the intersubjective field formed by the triad of a patient and the male and female co-therapists.     

Projective identification: A theoretical investigation of the concept starting from ’Notes on some schizoid mechanisms’1

This paper submits passages from four papers‐‘Notes on some schizoid mechanisms’ (Klein); ‘On identification’ (Klein); ‘Analysis of a schizophrenic state with depersonalization’ (Rosenfeld); and ‘Remarks on the relation of male homosexuality to paranoia, paranoid anxiety and narcissism’ (Rosenfeld)‐to a critical reading, enabling the theoretical premises which have produced the current, differing views on projective identification to be traced. These views revolve both around the role assigned to identification in the process and around the meaning of the expression‘to identify oneself with’ which in ‘On identification’ goes from ‘to feel similar to, or identical to the other’ to ‘to take another person as a model’. This legitimizes the inclusion of very different phenomena into the concept of projective identification. The author describes some uses of the term ‘projective identification’ and proposes the hypothesis that the process constitutes a way for managing otherness and the separateness of the object (be it external or internal, real or imaginary) that can compromise its reality to a greater or lesser degree. Covering a large set of phenomena, the author poses the question of whether it is useful to retain the term ‘projective identification’. She proposes an answer in the last part of the paper.     

A mismatch of meaning and intentionality between analyst and analysand

In this paper, I will consider a type of misunderstanding in the analytical dialogue and the possible unconscious motivations underlying this. I will also make reference to the patient's use of the analyst's words for the purpose of narcissistic enactment and will explore the extent of the analyst's involvement in this. The subjects of misunderstanding and narcissistic enactment will be dealt with in relation to a patient's way of processing certain interpretations at the beginning of analysis and the concealment of her way of processing the analyst's words. By contributing dreams and other significant material in the sessions, the patient gradually revealed her phantasies which enabled the analyst to uncover the possible factors which determined her particular attribution of meaning to the analyst's words and her retention of information about how she had initially construed his interpretations.     

On Murray Jackson's 1961 ‘Chair,couch and countertransference’

One of the problems facing psychoanalysts of all schools is that theory has evolved at a much faster pace than practice. Whereas there has been an explosion of theory, practice has remained, at least officially, static and unchanging. It is in this sense that Murray Jackson's 1961 paper is still relevant today. Despite the rise of the new relational and intersubjective paradigms, most psychoanalysts, and not a few Jungian analysts, still seem to feel that the couch is an essential component of the analytical setting and process. If the use of the couch is usually justified by the argument that it favours regression, facilitates analytical reverie and protects the patient from the influence of the analyst, over time many important psychoanalysts have come to challenge this position. Increasingly these analysts suggest that the use of the couch may actually be incompatible with the newer theoretical models. This contention is strengthened by some of the findings coming from the neurosciences and infant research. This underlines the necessity of empirical research to verify the clinical effectiveness of these different positions, couch or face‐to‐face, but it is exactly this type of research that is lacking.     

Between the Ability to Imagine and Actually Seeing: The Intersubjective in Reclamation

When working with severely damaged, neglected, and deprived patients, the analyst relies on the faith that the intersubjective analytic space can be the site of a live relationship. In this regard, the unique technique of “reclamation” might be used with patients in a moment of imminent danger or of a sense of psychic death and involves an active response to the sense of emergency in countertransference. Reclamation is based on the analyst/therapist's ability to conduct intersubjective dialogue between the various spaces of internalized object relations, and the author attempts to extend the possibility of its technical application by considering reclamation as intersubjective.