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A Case of Primary Vaginismus
(1999)
Sometimes human sexuality manifests itself in forms that must be interpreted as symptoms of a severely disturbed psychological situation. The author presents a case in which primary vaginismus – a long known symptom in the gynaecological field and difficult to approach both from a gynaecological and a psychological point of view – is the manifestation of a personality with psychotic elements.
A Contribution to the Settlement of the Historical Antinomy between Conflict and Defects in the Self
(1999)
Inquiring about the origin of mental distress from a relational point of view, the author focuses on the debate between conflict and structural defects, in order to overcome the dichotomy between the two different perspectives. According to the doctrine of defects in the self, which is based on certain Object Relations Theories, pathology is caused by faulty or inadequate caregivers. The doctrine seems too simplistic, because the child is thought of as completely passive. According to the relational viewpoint in psychoanalysis, the development of the subject takes place in a mutual conditioning process between the subject and the environment, which has to be better conceptualised. Defects in the interactive relationships with the primary caregivers, viewed as a failure in the relationship, create in the child a decompensation, which makes it withdraw from the relationship. In order to open itself to the relationship again, as a primal objectual need, the child builds up a pattern of response, which allows it to negotiate it again. Making use of the research on the first phases of development of R. Emde (psychoanalytic trend), C. Trevarthen (interactive-cognitive trend) and K. Kaye (child psychology), the author argues that the adherence to the structured response pattern leads to a conflict between the structured self image and any other potential different way of seeing oneself. Through a clinical vignette the author will demonstrate how this may lead to a non-cohesiveness of the self, viewed as an inactivation of the subject's developmental possibilities.
A New Start for the Continuation of MEGA-Project: Notes on the Recent Publication of MEGA IV/3
(1999)
Action in connection with the therapeutic process is often equated with acting out. The subtle behaviour that belongs to ?the complicated system of transmitting and receiving unconscious signals? (Sandler), with which the patient attempts to make the analyst behave as the object of transference or to fulfill an unconscious desire, is also described as acting out or micro-acting out (Treurniet). This fine-grained action, however, means nothing; it is not symbolic or communicative action. Its intention is, rather, to trigger effects and induce interactions. It occurs not only on the side of the analysand but also on that of the analyst, and is part of the unconscious communication in the therapeutic process. Presented here are some of the various interactive ways and means with which the analyst is prompted into unconscious action and certain, unnoticed, ways in that he turn ?treatsfithe patient. The analyst's action responses can bear the character of interpretations with which he may unintentionally reveal how he regards the behaviour of the patient.
The following report tries to compile the results of several research projects of the main author and his co-workers dealing with the exchange of affect within different types of relationships. Different conceptualizations of transference and countertransference as specific forms of creating relationships are described and the fundamental differences between successful psychotherapeutic relationships and empathetic every day relationships are outlined. Our investigations make it highly probable that transference is a very ubiquitous phenomena to be found in nearly every relationship as specific forms of affective scripts. The specificity of these scripts follows the disturbance with quantity and quality of the shown affect being the main differential marker. Within the severe disturbances we find reductions of affect with one remaining negative ?lead-affect?, with neurotic patients an excess of conflicts affects. Within the group of severe disturbances affect is attached to the self or to the relationship within neuroses and healthy subject to the objects the dyad talks about. The main difference between successful psychotherapeutic and every day relationships can be characterized by the fact that the therapist does not interactively react to the unconscious affective relationship offers, the patient makes, but develops instead those affects the patient is unable to generate, despite they would be urgently necessary from the meaning structure of the situation.
Anmerkungen des Herausgebers zu Band XI und zu Band XII der Erich Fromm Gesamtausgabe in 12 Bänden
(1999)
The theory of motivation proposed in this paper unites elements of psychoanalytic object relations theory, ego psychology and the theory of the drives. It is compatible with the theory of motivation proposed by Bischof. The wish for familiarity and the wish to relate to hitherto unknown objects, are both called basic relational wishes. The wishes for fusion, for relating to a person exactly like oneself, for being unconditionally accepted, the wish to be nurtured and to nurture some other person, the wish for being controlled or to control somebody else and for being admired because of gender characteristics, are called central relational wishes. These wishes correspond to the various stages of psychosexual development. They are characterised by the properties of the objects one wishes to relate to and by specific modes of relating. The influence of a person's being restricted to dyadic or multi-personal modes of relating to the intensity of central wishes is taken into account, as well as the influence of central relational wishes on the value system of a person.
This paper is a meditation on the interpenetration of mental and physical, particularly architectural, place. Its premise is that the relationship between person and place is transitional, ever in flux, person continually defining place into a continuous reality, and reality perpetually placing person. Further, this interchange occurs against the backdrop of an inconceivable void whereby the very terms of the interchange can be nullified. Such a void is unconscious and outside in the sense that it is outside what can be known. The matter of opening the inside to the outside becomes an endeavor shared by psychoanalysis and by architecture, notably sacred architecture. The exchange between inside and outside is considered using as examples the body, Freud's office, Disneyland, and the cathedral. Implications are extrapolated as to the provisional nature of the self.
Kohut's major contribution to psychoanalysis was in his systematizing a clinical approach to disorders of the self. Kohut's theoretical innovations, however, are often misunderstood for a variety of reasons, as evidenced in Dr. Meronen's paper, >The Return of Narcissism: Heinz Kohut in Historical Context<. Through redressing some of Dr. Meronen's misunderstandings of self psychological theory and his subsequent conclusions, I attempt to clarify in this discussion Kohut's sweeping technical innovations and the theory from which they are derived, all of which are reflective of Kohut's fundamentally personal vision of the essential nature of man.
Pathogenic parent-infant relationship patterns endanger developmental processes of children. Psychoanalysis with parents and their infants helps to diminish transgenerational repetition of maladaptive experiences of relationships. The aim of this extensive work is to transform dysfunctional relationship patterns and to change their self- and object-representations. The author gives an account of her experiences working in a counselling centre, where parents may come with their >problem babies<, infants with sleep and thriving disturbances or >ry babies<, and demonstrates the positive effects of a reconstructive and at the same time prospective work.
The paper discusses Frieda Fromm-Reichmann's theoretical contributions on the psychotherapy of psychoses and refers it to other authors' views. Today widely accepted, she stressed transference and countertransference as es-sential issues in the treatment of severely disturbed patients. She disagreed with authors like Federn who interpreted the concept of regression in a way that to treat schizophrenics means to treat children of different ages. Different from Federn, she advocated interpretations also of the positive transference to show the patient where he stands in life. Later on, Fromm-Reichmann opposed John Rosen and his direct analysis interpreting first the contents of the psychotic's speech. She stressed the form of the interaction and of the everyday behaviour where she saw where the patient stands in the world. The discussion shows that Fromm-Reichmann developed her theories and practice in cooperation and discussion with other psychoanalysts working with psychotic patients.
The paper discusses Frieda Fromm-Reichmann's theoretical contributions on the psychotherapy of psychoses and refers it to other authors' views. Today widely accepted, she stressed transference and countertransference as es-sential issues in the treatment of severely disturbed patients. She disagreed with authors like Federn who interpreted the concept of regression in a way that to treat schizophrenics means to treat children of different ages. Different from Federn, she advocated interpretations also of the positive transference to show the patient where he stands in life. Later on, Fromm-Reichmann opposed John Rosen and his direct analysis interpreting first the contents of the psychotic's speech. She stressed the form of the interaction and of the everyday behaviour where she saw where the patient stands in the world. The discussion shows that Fromm-Reichmann developed her theories and practice in cooperation and discussion with other psychoanalysts working with psychotic patients.
Fromm, Erich Pinchas
(1999)
Fromm, Freud, and Midrasch
(1999)
IFPS-Is there a Difference?
(1999)
This paper tries to answer a question about the difference between IFPS and other psychoanalytical institutions. The author states that there is a linkage between the ethics of psychoanalysis and the ethics of the institution. The ethics can not be represented by rules or standards of prerequisites, but by creating a space where the unconscious as desire, singularity and difference takes place. The bureaucratic organization and the hierarchy in the categories of members of IPA institutions goes straight against the transgressor experience of the unconscious. The training analysis under such conditions leads to an identification process with the training analyst, giving as final result standardized, homogeneous, obedient analysts. The author describes a new experience in the training of analysts in his institution without any kind of interference from IFPS. Finally, he concludes that differences exists between the two institutions and that they are mainly due to the identification process typical for IPA and the process of ''choice'' in IFPS.
Intelligenza emotiva e cervello emotivo: punti di convergenza e implicazioni per la psicoanalisi
(1999)
The author looks into the issue of interpretation and traces its evolution both from mere opinion, and from the point of view of the historical development of hermeneutics. In supervision interpretive dissonance may occur at several levels starting with the patient himself as well as his >gatekeepers<, and going up to the supervisor. The relationship between interpretation and supervision is examined in this context, taking into consideration the subjective and intersubjective levels of scientific inquiry. Supervision enhances the complexity of interpretation by introducing yet a third subjectivity that questions the supervisee's interpretation. This has advantages and shortcomings, as supervisors are not always aware that it is ultimately in the supervisee-patient situation where hypotheses are tested and confirmed. Theory alone cannot supersede the intersubjective situation. It is pointed out that psychoanalytic curricula should be reexamined in order to include semiotic science and its application to interpretation and supervision.
Kreativität und Schule
(1999)
Laudatio auf die Preisträger
(1999)
Le Coq-Héron
(1999)
Since its formulation by Bleuler in 1911, the generalisation of the term >autism<, mainly due to its use by Kanner in 1943 and its remake by authors of Kleinian inspiration, implies problems which mislead us, blurring our perception and understanding of clinical realities. Our psychoanalytical possibilities can be enlarged by a clear knowledge of the history of psychoanalysis, a dynamic approach to psychiatric classification and to problems related to our conception of the setting. On the basis of a case history the author shows how a child and its family worked through major autistic symptoms and proposes new approaches to some psychoanalytical concepts.
This article, which analyses a crime that took place in the city of Brasilia in 1997, is based on two separate and correlated hypotheses. Firstly, this crime reveals a fact about psychic structure: the >real< dimension irrupts through acts. Therefore, psychoanalytical practice must contemplate the >real< dimension. Secondly, we would like to pose two questions. Is it necessary for today's psychoanalysts to be aware of and involved with contemporary events? If the analyst ignores modern dialectics, what kind of symbolic involvement can he establish with the lives of the people he analyzes? Being committed to contemporary symbolic culture signifies that we must relinquish the comfortable division between good and evil. Acts of violence, performed by human beings, necessarily indicate both >enjoyment< and >truth<. In the symbolic dimension, we understand and comprehend; in the symbolic dimension, we are reasonable. But, not all acts fall within this pacifying register. If we consider these two aspects: on one hand, the analyst's responsibility to the patient, in regard to symbolic commitment and, on the other hand, the irruption of violent and senseless acts, this would mean that as analysts, we find ourselves lacking a certain neutrality, contrary to the position defended by some analysts.
There are many reasons why psychotherapy supervisees are prone to narcissistic vulnerability, in which feelings of self-esteem are challenged. In the supervisory process, the supervisee reveals his clinical ability, basic intuition and personal feelings, creating a powerful experience of self-exposure. Ego ideals towards which he aspires, compound this basic vulnerability. These ideals are challenged by the dual nature of mastery involved in the task of becoming a psychoanalyst. As a therapist, the supervisee is required to perform as something of an authority – if he is not yet an expert, he must appear to know a good deal more than the patient who is seeking his help, displaying some degree of mastery. As a student, he is clearly less knowledgeable than his supervisor, and, in the supervisory relationship, he displays his mastery in a very different way. There he is, at once, the >knowing< therapist and the >unknowing< supervisee. This paper examines the role of ego ideals and self-exposure in the experience of the supervisee, and explores special problems that occur with supervisees who present with narcissistic character defenses. Case vignettes are used to illustrate these ideas and implications for supervisory interventions are explored.
A essência psíquica do homem resulta de dicotomias existenciais que nascem da debilidade biológica da espécie e que naturalmente impulsionam os indivíduos a desenvolverem suas potencialidades éticas intrínsecas. Porém, uma vez na sociedade capitalista alienadora, o homem perde o espontâneo amor à vida e transforma-se alternativamente em terrível amor à morte.
Using a naturalistic design, 44 patients in psychoanalysis were examined with regard to qualitative and quantitative outcome of therapy. The results were compared with those from 56 dynamic and 164 inpatient therapies. Comparison of symptoms, diagnoses, and motivation prior to therapy led to the conclusion that the patient groups treated within these settings differed greatly. For this reason randomisation appeared to be an inadequate strategy for comparing groups in different therapeutic settings. Using different outcome criteria, it could be demonstrated that psychoanalysis patients on the whole attained good therapeutic results. The outcomes were the best in comparison with the other two therapy categories investigated. The use of different outcome criteria and observer perspectives (patient and therapist) led to therapy results with clear-cut differences. In the patient view, the main effect was cessation of psychosomatic, anxiety- and depression-related symptoms. The therapists furthermore reported clear-cut changes in the scales depicting relationship variables. The study presents success rates obtained on the basis of different outcome criteria and discusses them with special emphasis on the methodology of recording outcomes. The paper concludes by making recommendations for psychoanalysis studies yet to be planned.
La proyección, desde referentes marxistas y humanistas, de los principales conceptos del psicoanálisis aplicados al ámbito de la acción de la persona y de la situación social constituye una línea de pensamiento e investigación fructífera para la solución de los problemas de la sociedad contemporánea. La importancia metodológica de categorías holísticas como la de Proyecto de Vida, construída y aplicada en diversas investigaciones por el autor podrían aportar, desde los referentes teóricos que se expresan, a la complejidad del campo de conocimiento y tranformación humana de la sociedad.
Rationaalisen demokratian paluu? Jürgen Habermas Frankfurtin koulun ohjelman demokratisoijana
(1999)
Reply to Ann‑Louise Silver
(1999)
Sándor Ferenczi's first paper (1908) on the subject of premature ejaculation – in its stress on the repercussions of the symptom itself in the other (in this case, the woman), rather than its unconscious significance or the patient's pathology – is an early signal of the ethical directions his future clinical work would take. Ferenczi – displaying a decidedly relational, not merely intrapsychic, orientation – underlines the peculiar idiosyncrasies of each partner in the couple and also the fact that any relationship worthy of the name must take place in conditions of mutual pleasure and advantage. In particular, Ferenczi strikes a blow for the >legitimate< needs of the weaker partner to whom the stronger must allow and offer mental space and voice by virtue of his knowledge and power. For the above reasons this first paper is a >calling card< which announces Ferenczi's later reflections on the specific affective qualities that may render the psychoanalytic environment non-traumatic, as well as his criticism of the narcissistic aspects of the analyst (one of the most important motives for subtle and hidden trauma), who views the work of interpretation as the product of a single mind (in my terms: a kind of colonisation and expropriation of the other) rather than as fruit of an encounter that would take into account both the unique characteristics of the partner as well as the rhythms appropriate to such a relationship.
Psychoanalysis is the product of a highly original and independent thinker from an historically marginalized minority with a perspective dedicated to plumbing the depths of our self-deceptions. Although the European anti-Semitism faced by Sigmund Freud was particularly relevant to his personal and professional identities, he was not unmindful of conflictual >race, creed and color< paradigms peculiar to the >New World<. Fragments from the analyses of two American psychiatrists (whose formative years were centered in the post-Civil War South) reveal the confluence of such crosscurrents in their autobiographical accounts of his inter- relationships with each of them.
Since Freud's Dream Interpretation and his additional writings on the analysis of dreams, the technique of handling a dream report within the analytic session has remained nearly unchanged. It is characterised by dream-centred associations and their interpretation in regard to dream content and to transference. This approach constitutes an alien element within contemporary interactional psychoanalytic technique and tends to provoke resistances in the analytic dialogue. This article stresses the function of dream reporting during the session with respect to the interactional process. It is concluded that sufficient attention should be given to interactional analysis of dream reporting in accordance with the questions: Why does the patient at this point of the process tell a dream, and why does he tell this very dream instead of another?
The Dream Unbound
(1999)
Since the publication of Freud's Interpretation of Dreams, the psychoanalyst has been concerned with how to bring the unconscious mind closer to consciousness. This paper reflects the shift in understanding the use of dreams for the psychoanalytic exploration of the vicissitudes of the self and a shift away from the notion of wish fulfillment as a core motivational force in wish production. Another important change in psychoanalytic theory is the relevance of the analyst's subjective experience of the patient, which enhances the understanding of the therapeutic process. From the acknowledgment of the importance of a countertransference dream, the analyst has greater access to thoughts, feelings, and images which enable the analyst to work through the resistances to change, which occur in the consulting room. Two clinical vignettes depict the use of self-state dreams which reveal the patient's self-experience and a countertransference dream which gives greater access to the analyst's inner world and thus wards off a potential dismantling of the psychotherapeutic relationship.