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The psychoanalytic movement is experiencing a serious crisis: its scientific consensus, social standing, and impact on practice in mental health have all been steadily declining over the last decades. This unfortunate process has been variously explained in terms of prevailing hedonistic social values, the political influence of drug companies, and cuts in health-related expenditures. Following a suggestion by Garza Guerrero, we rather believe that the sources of the contemporary crisis in psychoanalysis are to be searched for within its own development and current social and cultural life. Specifically, we think psychoanalysis has failed to bring the revolutionary contribution of interpersonal and intersubjective paradigms to its fuller consequences. Here, we review five core dimensions in which such failure is particularly apparent: (1) an unwitting reliance on the medical model of mental illness; (2) an ontological, concrete understanding of unconscious processes; (3) a manifest failure to fully appreciate the role of extratransference relationships in the patient’s life; (4) a naive and idealized view of the psychoanalyst’s person and role; and (5) a marginal awareness of the impact of group-level unconscious phenomena on the social life of psychoanalytic institutions.
The paper attempts to explore the patient–analyst contribution to the analytic process – focusing mainly on the contribution of the analysand – and how their mutual influence might affect the outcome, sometimes beyond the analyst’s capabilities. This is approached through exploration of the co-creation of an intersubjective analytic field by the analytic dyad, in which the analytic phenomena occur, somehow in both participants, but in an asymmetrical way. Their co-creation of the analytic third in this space includes conflictual as well as healthy elements of themselves. The analyst’s professional self and the analysand’s healthy ego parts form an unconscious alliance directed towards a common cause, the progress of analysis, which unavoidably affects both. Clinical material and vignettes from three cases are presented. In these, becomes apparent that the patient can temporarily take over the analytic situation, permitting continuation of the analytic progress. It is argued that, through the above process, a patient can often help and support the analytic process, surpassing the weaknesses and defects that their analyst might have. Influences on patients’ developing mentalization.
Treatment for drug-induced depression usually consists of cessation or reduction of the causative agent and psychopharmacologic management. In addition, psychotherapy can be useful as an adjunctive treatment. The author presents case material related to a young woman with an inborn physical illness, who became depressed during the course of interferon treatment for a medical complication, hepatitis virus infection. In addition to the cessation of interferon and pharmacologic management, supportive psychotherapy of a psychodynamic orientation was started in order to address the patient’s low self-esteem and anxiety about her future. During the course of psychotherapy, it was understood that the premature cessation of interferon was, to her, a narcissistic injury. It was also important to explore the meanings of her inborn illness and her guilty feelings. After reviewing various formulations of depression, the author discusses the case material from an integrative perspective, which describes vicious cycles of depression.