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In. Reply to Altman's and Schellekes's questions and discussion, the author explores in more depth his own theoretical-technical point of view in order to clarify – chiefly in the light of a modern application of Ferenczi's and Heimann's way of thinking – the rationale for the selection of clinical facts in his paper.
In response to Franco Borgogno's article, the author talks about the dread of falling, a theme that appears in some of the dreams presented in Borgogno's case study and that conceals very primitive anxieties, each resulting from specific object relations constellations. The discussion elaborates the understanding of this dread through various theoretical perspectives as well as through Samuel Beckett's (1946) short story, >The Expelled.<.
The thoughtful discussions of my paper by Alan Schore, Wilma Bucci, and James Fosshage raise important considerations about the relationship between theory, research, and the micromoment interactions constituting the activity of psychoanalysis. For the opportunity afforded by their contributions, and to Psychoanalytic Dialogues for publishing our exchanges, I express deep gratitude. I am initially impacted by the appreciation shown by my colleagues for the approach I am illustrating to clinical attention and its value for an expanded and, in certain ways, revised scope of psychoanalytic activity. In particular, I am appreciative of the ways that each commentator has taken up my emphasis on expanding psychoanalytic attention beyond symbolic pathways of exchange and has further contributed to understanding how this can occur. As part of a consideration of points of convergence and difference between us, I address how such convergences and differences shape both the values and pitfalls of comparisons across research, theory, and practice.
Steven H. Knoblauch has been developing a strategy and theoretical perspective for using and understanding complex nonverbal experiences and communications that occur in the analytic exchange. His delineation of nonverbal communication contributes substantially to the ongoing expansion of our views of psychoanalytic interaction and theories of therapeutic action. This expansion, contributed to by many, involves the development of an interactive systems model in which verbal and nonverbal communications are viewed as actions occurring at explicit and implicit levels. In a number of Knoblauch's clinical illustrations, subsymbolic processes rapidly invoke, or are invoked by, nonverbal or imagistic symbolic processing and meaning-making as well, often followed by verbal symbolizing processing. Subsymbolic and verbal and imagistic symbolic processing, intrinsic modes of organizing data, probably continually influence one another bidirectionally in a flowing feedback loop.
Bucci's model of emotional communication, developed in the context of her theory of multiple coding and the referential process, is applied to Knoblauch's microanalytic report of his experience of the patient and himself and their interactions during a single session of an ongoing treatment. The referential process is a bidirectional function connecting the diverse sensory, somatic, and motoric representations of the subsymbolic system with imagery and words. The process operates partially and to varying degrees within both participants in the case presented here, the dissociation among systems is severe, and emotional communication within the dyad occurs at first primarily in subsymbolic, bodily forms. Where gaps in the referential process exist for the patient, the analyst's own experience and associations operate to evoke new connections for her we see this process in moment-by-moment glimpses of the analyst's experience and his interactions with the patient. Gaps in the reader's knowledge, and possibly the analyst's knowledge, of the patient are discussed.
In October 2004 it was my pleasure to present at a cutting-edge conference entitled The Interplay of Implicit and Explicit Processes in Psychoanalysis. In addition to offering an address (>The Essential Role of the Right Brain in the Implicit Self: Development, Psychopathogenesis, and Psychotherapy<), I also provided a commentary to Steven Knoblauch's excellent paper, >Body Rhythms and the Unconscious: Toward an Expanding of Clinical Attention.< In the following, I briefly summarize these presentations, with the purpose of showing how current advances in developmental and neuropsychoanalysis are being incorporated into the practice of clinical psychoanalysis. This work is part of an ongoing effort to expand regulation theory, an overarching theoretical model of the development, psychopathogenesis, and treatment of the implicit self.
Wish, Need, Drive: Motive in the Light of Dynamic Systems Theory and Edelman's Selectionist Theory
(2005)
Limitations to the process of symbolization for communication in psychoanalytic work are considered as the basis for an expansion of clinical attention to include embodied experience as a source of unconscious meaning. The displacement effect of language and the futility that language meets, as description of lived experience, are key points recognized in the contributions of Daniel Stern and Jacques Lacan. Irwin Hoffman's critique of assumptions underlying Freud's technique for analytic work are reviewed as a point of departure for recommending a relational approach to analytic attention expanded with an emphasis on micromoment-embodied communication in addition to symbolized communication. A clinical narrative is offered, highlighting the rhythms of movement between embodied and verbally symbolized communication as a basis for constructing unconscious meaning. The implications of this approach are summarized for expanding analytic attention to include registers of communication in addition to the verbal symbolic.
This paper revisits the case of >Karen< (>Whose Bad Objects Are We Anyway? Repetition and Our Elusive Love Affair with Evil,< PD 14/6) eight years after the time period described in the earlier paper, and uses this case material as a backdrop for discussing a relational reformulation of the termination process. The paper posits that an analysis conducted around a model of mind that holds multiple self–other configurations as the fundamental organizing structures needs to take these self–other configurations into account in ending an intensive treatment. Therefore termination becomes, from this perspective, a series of endings between multiple self–other dyads that have emerged during the treatment process. Extended clinical material is provided to illustrate this point of view.
Stephen Wangh's thoughtful essay on revenge and forgiveness in Laramie, Wyoming, raises a number of questions about the role of psychoanalytic theory in shaping as well as reflecting culture. The events that took place in Laramie cannot just be material for psychoanalysts to examine and interpret. Rather, Laramie is a mirror that forces us to reflect on ourselves and our own contribution to the killing of Matthew Shepherd because he was gay. Psychoanalysts have described gay men as immature, predatory, paranoid, narcissistic, sadistic, masochistic, and pitiable. As the major discourse on gender and sexuality in the Western world, we have been and remain an influential part of the larger context in which gay men become the targets of hatred disguised as moral outrage. Rigid gender prescriptions add to the problem by pathologizing some groups and idealizing others. Psychoanalysts need to acknowledge this homophobia and its consequences directly and begin to rethink theory along more intersubjective, less value-laden lines. Some parallels to the South African truth and reconciliation movement are suggested.
Davies contributes to the development of relational theory by formulating and illustrating what occurs during especially difficult moments in an analytic exchange. In understanding enactments, Davies importantly underscores the contribution of both the analyst's and patient's >bad objects.< This author attempts to build bridges between Davies' language and concepts anchored in object relations theory and this author's language and concepts based in contemporary or relational self psychology, including the integration of cognitive psychology. In addition, this author delineates the use of the >empathic,< >othercentered,< and >analyst's self< listening/experiencing perspectives to explicate the case material and to provide alternative understandings and pathways for psychoanalytic work. The thesis set forth is that the use of different listening/experiencing perspectives expands choice for the analyst when working in difficult moments of the clinical exchange.
Replying to eight commentaries on my paper submitted by readers of this journal, I address such disparate issues as matters of training and supervision, theories of regression, the analyst's self-states, the patient's vital purpose, complexities of doing for the Other, and the question of what needs to be spoken (interpreted, formulated, declared) explicitly between patient and analyst. I further explore the meaning of my stating to my patient that I would not hug her in our analytic work ahead. And I respond to questions regarding my concept of the paradoxical analytic triangle.
Stuart A. Pizer's fascinating article explores through a relational lens analytic impasse, and its manifestation through transference and countertransference love. How this love is demonstrated (or not) and the ways in which we provide for our patients will have profound effect on the process (and progress) of any treatment. But, too often, reluctance to >do for< our patients compromises our ability to provide what may be needed in any given moment. Perhaps an expansion of the >doer – done to< dyadic paradigm into a >doer – done for< model might allow more analytic leeway and more possibility of growth within our patients.
This case provides a delicate approach to vital purpose, unconscious pattern, and >emotion recollected in tranquillity.< The author defines, the >paradoxical analytic triangle< to which Pizer refers, as a human quality, an unprecedented level of understanding and comprehension, that lets analyst and patient recognize their own dependence on the object. In so doing, they both gain a quality of presence through recovering the projections that they have attributed to the object. Four aspects are considered important steps leading to this human quality within the analytic process: dissociation leading to impasse sensibility opening to countertransference recollection in tranquillity leading to self-reflexivity and the patient's >vital purpose< – the most salient aspect (the lighthouse) of the whole project.
It seems it would be helpful for all impasses to be >recollected in tranquility.< In the thick of impasses, however, when we are experiencing pressure, defensiveness, vulnerability, and the responsibility to come up with a quick solution, it can be nearly impossible to think clearly. Time may take us to a place of greater calm and fresh awareness. But it may also provide an illusory calm, leaving us stuck circling in old familiar grooves, grooves rimmed by our own unconscious vulnerabilities and limitations. At such times, we may operate in a perceived state of calm, but with a set of powerful, yet ineffective, unseen or outgrown, concretized beliefs and perceptions, creating a perception of calmness. Some of these may even silence or damage the cooperative or struggling patient, who remains or dares to return (out of a longing to connect or make things >right<). I wondered whether what Dr. Pizer's patient said at the end of Rebecca's second therapy with him was true (that she no longer needed a hug from him, finding it more mature to proceed without one), or if this was merely what she felt she should say in order to leave a key relationship she valued – also in peace and tranquillity.
This discussion of the paper by Stuart Pizer focuses on the unconscious forces operating within the analyst that can contribute to a therapeutic impasse. The author discusses a period when she unknowingly skirted interpersonal and transferential interpretations as a result of particular stresses in her personal life. It was not until she was taken to task by one of her patients that she realized the extent to which these stresses had led her to back away from the intensity of the therapeutic relationship. This discussion is offered as a cautionary tale, to remind every analyst of the importance of remaining as aware as possible of one's own circumstances, history, dynamics, and limitations and to be forever watchful of oneself.
This discussion addresses two key points concerning Pizer's thoughtful paper about a long-term, difficult analytic process. First, it responds to Pizer's quest for theoretical and clinical concepts that do not limit the analytic work of mature, experienced analysts to interpretive work, but reconnects them theoretically, clinically, and technically with deeply engaging emotional experiences of life-giving, profound transformation through treatment. The author suggests that the clinical theory of therapeutic regression, which was developed and forged within intense and difficult analytic treatments, brings the critical need for fundamental experiences of the analyst's loving and sustaining provision into the framework of the psychoanalytic process and therapeutic action. The discussion further elaborates on the emotional risking and vulnerability – the venture zone, as the author terms it – that creating psychic change implies for both patient and analyst. This venturing by both of them is illustrated through the clinical example presented by Pizer in his paper.
In our response to Pizer's paper, we underscore the importance of discerning when to more deeply and conjointly explore emergent intersubjective moments in the therapeutic exchange. Pizer states that he would not now proceed clinically in the same way that he conducted his first treatment of his patient Rebecca, which occurred prior to his receiving full analytic training. However, he questions whether the therapeutic engagement would have advanced as well as it did if he had not offered various sponsoring and sheltering provisions to his patient. We believe that a more reflective and self-aware Pizer could have both supplied the provisions that Rebecca so desperately needed and more actively explored the meanings of their experiences together. Further discussion is needed regarding how impasses result when deepening analytic reflection and interpretation are not used to negotiate the multiple and paradoxical relationships that develop in treatment. In addition to training and consultation, we need to identify and utilize various ways to better understand what interferes with our capacity to negotiate the balance between remaining true to our own subjectivity and being enough of what our patients need us to be.
In providing the background to a pivotal session, Stuart Pizer reveals his clinical work as an unsupervised neophyte, prior to his own analysis and analytic training. These early therapeutic efforts were flawed, leaving Pizer at times >grimacing with mortification 26 years after the fact.< But they were also extraordinarily helpful to the patient. Schaffer discusses the challenge of supervising similarly talented beginners: how does one teach psychoanalysis without desiccating a treatmen? How does one teach a relational approach, with no >basic model< and few rules, to a beginning analyst infused with an unformulated, yet often passionate, sense of what is >curative<? Pizer recognizes that were he to meet the same patient today, he would not conduct the same treatment. Now trained and analyzed, not to mention more cautious and >worldweary,< Pizer would not do what he did then. But what if he were the supervisor then? Schaffer concludes her discussion by asking Pizer how he, now a seasoned analyst, would supervise his early therapist self.
This article examines a debate concerning the exegesis of the story of the garden of Eden and the tree of knowledge, as told in Genesis. Two contradictory interpretations of the garden narrative are examined, the first as the story is elucidated by the psychoanalyst and social theorist Erich Fromm and the alternative interpretation by the Talmudic scholar and philosopher Rabbi Joseph Soloveitchik. This article compares and contrasts their exegeses and the respective implications of each view. The controversy, which has profound implications, reflects differences in world views concerning the good life, autonomy and relatedness, assertion and submission, will and surrender, obedience and rebellion, independence and interdependence, subjectivity and intersubjectivity. Links are drawn to a variety of contemporary psychoanalytic theories, developments, and controversies.
The progress of psychoanalysis and psychotherapy depends on our capacity to study, in a scientific manner, the process of therapy. Since a study of this kind involves charting the waxing and waning of something as elusive as the sense of personal existence, the task has, in the past, been seen as virtually impossible. However, words, or more particularly, the way words are used, manifest such shifting states. Sophisticated linguistic analyses are available, providing the means to conduct these necessary studies. This article suggests that an ongoing sense of personal existence, which William James called >self,< is multilayered, in the manner of the poetic, and that indices of such layering will reflect beneficial change. The description of this zone of experience, which might be called the synchronic, depends on contributions from Marcel Proust, Virginia Woolf, Henri Bergson, and Ferdinand de Saussure. An illustration of the value of a consideration of the minute particulars of the therapeutic conversation is given by means of extracts from therapy sessions seven months apart.
Freud's theory of melancholia has lately experienced a renaissance among those interested in the creative potentialities of the psyche. In this essay, I consider the ways in which melancholia can contribute to the actualization of these potentialities by preparing the ground in which inspiration can later take root. I also outline the circumstances in which the melancholy subject's refusal to abandon its lost objects represents an entirely valid response to loss. At the same time, I propose that if the subject is to develop an affirmative and imaginatively supple relationship to its psychic history, it must in the end move from melancholia to meaning production. Insofar as melancholia signals the psyche's inability or stubborn unwillingness to move forward, its powers by necessity remain dormant until the subject is able to exchange its sadness for the versatile meaning-making capacities of the signifier. I moreover argue that it is only when the subject is able to transcend its melancholia enough to begin to desire new objects that it can develop loving and responsible relationships with others – that it can begin to welcome others in their own terms rather than reducing them to its own narcissistic image.
Burton's response to discussions by Krystal and Khantzian addresses the manifestation and engagement of aspects of bad objects in addictions treatment and acknowledges the broader relationship between compulsive behaviors and dissociation. In addition, Burton presents thoughts on cross-disciplinary communication and an emergent relational metapsychology and its potential impact across schools of psychotherapy.
Commentaries by Edward Khantzian and Henry Krystal allow me to elaborate the role of dissociation in addictive disorder, and its misguided place in the design of many therapeutic strategies to overcome it. Promising direction for the treatment of the characters and symptoms of drug-dependent patients lies in the application of developments in current analytic theory and technique. Such developments include familiarity with enactment, dissociative and projective processes, and work in a two-person frame to enable treatment to encompass and reach more of the patient.
The two papers on the psychoanalytic treatment of addiction are important contributions and provide us with newly organized tools and techniques. Emphasizing the dissociative reactions in this area also highlights the issues we encounter in the analysis of the addictive type of personality. Both the transferences and the countertransferences need special attention because they are difficult for every patient and analyst. Thus we are alerted to these individuals' great neediness and dependency and their desperate defenses against confronting the core problems. After all, their personalities are dominated by their need to escape, deny, or block their lifelong misery. Hence, the burden is for the analyst to deal with his or her own feelings of boredom or helplessness, and the challenge is to handle the patients in a supportive and yet interpretive way in the interactional and relational cooperation. These new insights and review of old principles will reward the reader.
The author discusses papers by Director and Burton, placing their work in a context of contemporary psychoanalytic models for understanding addictive behavior. Whereas early psychoanalytic models stressed drive theory and a topographic model of the mind, the contemporary models discussed here emphasize themes of dissociation – integration, helplessness – omnipotence, self-organization, and relational therapy. The author considers how these modern themes resonate with psychoanalytic formulations of addictive vulnerability that have considered disturbances in affect recognition/tolerance, self-esteem, relationships, and self-care. The author concludes by suggesting that the dyadic paradigms advanced by Director and Burton likely have implications for psychodynamic group treatments.
Relational perspectives on the nature of self and the unconscious have transformed how we can understand addictions and substance use problems. Addictions have received little attention in the contemporary literature and therapeutic approaches outside of psychoanalysis have been skeptical of psychoanalytic approaches. It is my contention that viewing substance use problems through the lens of a relational/multiple self-state model offers new clinical possibilities resulting in greater success in treating these patients. In this model, addictive behavior is seen as embedded in dissociated self-states. Therapy focuses on helping the patient to move from dissociation to a true multiplicity and a decreased dependence on substances.
An assumption made in this paper and explored for its clinical implications is that an act of chronic drug use often marks or serves to implement an underlying omnipotent self-state. Psychoanalytic work with substance users, as compared with other approaches, trains attention on these omnipotent states and makes use of the transferential exchange as a therapeutic tool. States of omnipotence are particularly examined here in the context of recent attention to dissociation as an organizing force in the personality, and in the configuration of the transference – countertransference of the treatment relationship. A case illustration is used to apply current thinking on dissociative and projective processes, and their role in enactment in the therapeutic exchange, to illuminate the frequent interplay of omnipotence and helplessness in analytic work with substance-using and other patients.
In. Replying to the discussions of Gilbert Cole and Stefanie Solow Glennon, I focus on several issues raised, including the continuing intrapsychic relationship with a dead parent who may have been destructive to the patient the analyst's facilitating role in enabling the patient to connect with, and construct the future of, the lost relationship the potential meaning of an enactment with a bereaved patient and some thoughts on the dyad's needs to work creatively postloss in multiple affective time zones.
The author makes use of Glennon's and Cole's discussions to elaborate the relationship between our conceptions of self and the ways in which we understand the experience of loss. In discussing the intrapsychic self, the self as it is constituted through the process of relating and the existential self, he argues that when we make room for multiplicity and the complex, dynamic interplay of diverse self states and modes of experiencing, these different conceptions of self both enhance and complement our experience of loss.
What is a selfobject?
(2005)
This discussion examines the theme of time as it is experienced by someone who has suffered a loss, in an attempt to understand and differentiate certain contrasts in these authors' approaches to theory and technique. The discussant argues that the frame is a vital tool in helping the analyst to gain access to the differential interplay between awareness of mortality and our flight from it. Finally, the discussant asks whether certain prevalent relational themes, such as mutuality, empathy, and the ubiquity of enactments, have contributed to an atmosphere in which attention to the frame can recede.
This commentary highlights the differences between Frommer's and Sussillo's views on what might be done in the clinical situation to promote beneficial mourning. Sussillo is concerned with maintaining an intrapsychic tie to the deceased parent of an adolescent to lessen the ravages of loss. Her advice to analysts is to promote that internal connection through specific questioning about the lost parent and encouraging the patient to directly address the deceased other. Frommer's focus is on how best to facilitate an ongoing psychic connection to mortality through a shared experience of loss with the analyst. His therapeutic goal is the intensification and appreciation of the now as a route to more fulfillment in living. Glennon asks Sussillo what might be different in her conceptualizations if the lost parental relationship had been destructive instead of growth enhancing. Glennon also is concerned about the possibility of a renewed experience of loss being the ultimate outcome of maintaining an intrapsychic tie. Her concern regarding Frommer's conceptualizations has to do with possible psychic difficulties involved in keeping grief in the forefront of one's mind.
What Grounds Creativity?
(2005)
The author considers a relational perspective of mourning and suggests an elaboration and extension of Freud's theory of mourning with a sharper focus on the dialectic of holding on and letting go of the formative lost object relationship. Sussillo argues that Freud's early (1917) theoretical tilt toward the relinquishment of affective ties with the dead, later expanded and culminated in a deeper relational sensibility, was shaped by his developing theories and personal losses. Her position is that the analyst can help facilitate the adult patient's affective experience of felt continuity with the absent object, lost in adolescence, that ultimately allows the separation and the transformation of the primitive bond. Sussillo's perspective represents a synthesis of relational theories in a broad sense – also informed by attachment theory, contemporary bereavement research, infant research, and developmental theory. This thesis is illustrated by a clinical example that highlights the therapeutic action.
Our mortality – the fact that we will die and that we know it – defines the human condition, although this knowledge is often defensively maintained psychically as a theoretical, intellectual proposition. This paper explores one route by which such knowledge is transformed into felt experience: I suggest that how we mourn – what occurs psychically as we live the pain of loss – strongly influences our relationship to our own deaths. Because the psychic labor involved in making mortality real has compelling individual and social consequences, I position the role of the psychoanalyst as well as intersubjective aspects of the psychoanalytic process as central to helping patients grapple with their own mortality.
My response to the discussions is organized from an evolutionary perspective on the development of theory within psychoanalysis. After briefly stating the premises of the paper, I discuss each commentary. I experience Aron's discussion as more evolutionary than Benjamin's or Ellman's. It seems clear that we all have our own agendas. The reader is invited to try them on for size in the spirit of ongoing dialogue that characterizes this journal.
This paper distinguishes three types of Freudians and argues that Rothstein incorrectly identifies himself as a compromise formation theorist. There is a short depiction of nonclassical Freudian position, and this position is juxtaposed with Brenner's version of Freudian theory and technique. There is a detailed critique of Brenner's version of compromise formation theory and the clinical implications of this theoretical position. The discussion concludes with a description of intersubjectivity and distinguishes two meanings of the term. One meaning is both compatible with and enriches contemporary Freudian thought, while the other polarizes positions and is not easily accepted in any Freudian position.
The author discusses Arnold Rothstein's paper >Compromise Formation Theory: An Intersubjective Dimension< and challenges his definition of intersubjectivity. She offers a perspective in which the import of intersubjectivity theory is less to dissolve the notion of objectivity than to grasp processes of mutual engagement, regulation, and recognition. While it is true that the recognition that the analyst is also a subject and therefore does not have exclusive knowledge is an important shift in the psychoanalytic paradigm, the author suggests that the intersubjective is far more encompassing than this. Intersubjective theory emphasizes the active creation of consensus or conflict about reality rather than merely the recognition that the analyst's perspective on reality is subjective. This cocreation produces a different emotional experience of connection, not merely a change in the quality of insight. Finally, Rothstein's case illustrates how he responds to the need for recognition and regulation. He shows us how focusing on the procedural allowed him to make an intersubjective shift, not simply an intrapsychic interpretation of compromise formation.
In this commentary on Arnold Rothstein's >Compromise Formation Theory: An Intersubjective Dimension,< I address some of the limitations of compromise formation theory in addressing issues of intersubjectivity. Namely, compromise formation theory does not address intersubjectivity as a principal motivation it takes up mutual regulation but not mutual recognition or other aspects of intersubjectivity it does not place the intersubjective matrix at the center of clinical psychoanalytic understanding and it does not sufficiently examine clinical concerns regarding the patient's conflicts regarding intersubjective contact with the analyst. I then discuss Rothstein's clinical vignette in an effort to provide an alternative understanding of the therapeutic action of Rothstein's clinical interventions. Drawing on the work of the late Lloyd Silverman, I present an intersubjective explanation that highlights the analyst's compassionate understanding of the patient's conflicts and acceptance of the pleasure in the patient's impulses, achieved through the analyst's own personal and subjective struggles.
This paper has two purposes. The first is to elaborate compromise formation theory from an intersubjective perspective. The second is to explore the implications of this vantage point for our understanding of the modes of therapeutic action of psychoanalysis. I pursue the goals of this paper by outlining the essentials of compromise formation theory and by elaborating what I mean by its intersubjective dimension. Then I present and discuss analytic data to demonstrate the value of the theory for understanding aspects of mode of therapeutic action. Finally, I contrast this perspective with competing theoretical points of view.
Two ways of being
(2005)
Neil Altman and Rachael Peltz have written forceful and important papers on manic defenses and the loss of >social security< in American society. My own experience underscores the value of their project, which I view as a response to changes and differences that have grown over decades and accelerated in recent years. The emergence of the theory of manic defenses leads back to the crises of the 1930s, and psychoanalytically informed cultural critics have recognized similar patterns since the 1970s. I suggest evidence for their views, while also expressing skepticism about their more prescriptive ideas. The crisis they begin to analyze has even deeper roots in the ultimate fears generated in the mid-20th century.
Traumatic social violence provokes adaptive transubjective phenomena of banalization, familiarity and obviousness, which can be understood as a 'defence through ambiguity' that leads to an 'adaptation to whatsoever'. In a state of ambiguity there is numbing of critical thinking and of the alarm mechanisms. During the psychoanalytic process with survivors of social violence (torture, etc.) we can find a secret refusal of the external alienating situation in the intrapsychic representation of an 'object to be saved', an object of concern. In this paper, Ferenczi's concept of 'identification with the aggressor' (introjection of the culpability of the abuser on the child's subjectivity) is compared with this clinical experience. We try to understand and challenge through comprehension and insight the subjective consequences of traumatic social violence, in the three spaces of subjectivity (intra-, inter-, trans-) considering psychic dynamics in relation to reality contexts.
This commentary on papers by Neil Altman and Rachel Peltz argues that while the type of political culture in which one lives has a significant impact on the practice of psychoanalysis, no direct line can be drawn from psychoanalytic theory to any particular political persuasion. It is one thing to argue that psychoanalytic insights offer a way of thinking about political relations it is quite another to suggest that they can be used to promote or justify a political agenda. While Altman and Peltz theorize about the negative impact of manic defense in contemporary culture, this commentary suggests that there are natural fluctuations in one's ability to respect inner reality and a degree of manic defense employed in everyday life that is quite normal. We all use reality to gain reassurance against death inside. But, when we are >distracted from distraction by distraction< (Eliot, 1971, p. 120) external objects are prematurely deadened so that the needed reassurance through external reality becomes increasingly elusive. Challenging some of Altman and Peltz's political assumptions, the commentary suggests that if psychoanalysis is to contribute to the political realm, it must do so on the basis of how it differs from other approaches to understanding what it means to be a human being.
Transferred fictions
(2005)
Neil Altman and Rachael Peltz suggest the relevance of psychoanalytic ideas drawn from the object relations tradition to understanding contemporary American social life. They see the denial of suffering and the projection of hostility in an increasingly individualistic culture as a >manic defense.< While sympathetic to this critique, this commentary raises questions about it. It argues that the object relations perspective is only one of several versions of psychoanalytic thinking. Psychoanalysis is neither value free nor committed to one set of values, but is rather a plural discourse within which moral and social differences can be explored. The paper suggests three ways for advancing the critical program set out by the authors. It recommends that clinical work be used as a valuable source of evidence of the consequences of social organization for personal lives, that arguments based on case descriptions of individual experience can be effective forms of public communication, and that the value of the >containment model< presented by Altman and Peltz needs to be demonstrated in practice as well as in theory, through psychoanalytic work both in and beyond the consulting room.
This paper reviews how the bond between the therapeutic relationship and transference is created, illustrates its technical management, and provides a basic methodology for the exploration of both transference and the therapeutic relationship. For this purpose, the current therapeutic relationship, the concept of affective dominance, the object relation triggered by transference, the past and present unconscious, and the relationship pattern (CCRT) applied to dreams will all be considered. The approach in this paper is based on an object relation conceptualization. Highlights of the theory underlying the technique will be illustrated in a succinct discussion of the clinical treatment of a borderline patient in psychoanalysis.
In this article I maintain that, as a society, we are lacking a basic commitment to the social equivalent of Winnicott's >environmental provisions.< Though we live in a democracy with certain inalienable rights, we have not instituted a system of governing authority to protect those rights. Instead, the needs of the market have taken precedence, overriding the needs of the populace. I believe that psychoanalysis can be used to inform political and social policies by underscoring the importance of the environment (familial and societal) and of the responsible agents (parents and governmental institutions) to provide an environment that fosters growth and creativity. I suggest that one internal, psychic response to the lack of a system of governance that guarantees the provision of basic environmental needs is the proliferation of manic defenses. Compulsive consumption, a behavior our market heavily relies upon, rates as one of the many socially sactioned manic attempts to ward off the pain and anxiety associated with both the absence of a containing governing authority and the loss of basic provisions including health care schools safe water, air, and food energy and other needed resources. A composite clinical picture will be presented to illustrate the manifestation of manic defenses. These defenses will also be discussed in relation to the changing role of work in this society.
I argue that on both the small-scale level of the interpersonal relationship, and the large-scale level of society, the manic defense makes it difficult to care about others, and so militates against a sense of social responsibility. I address four basic questions: what is the nature of social responsibility? What is the nature of the manic defense? How does the manic defense interfere with the potential for social responsibility? And, on a more general level, what are the issues with respect to methodology for efforts such as this one to link psychoanalysis and social theory?
Nonlinear dynamic systems theories offer useful approaches for understanding psychoanalyses: One of the most distinctive and appealing features of psychoanalytic thinking is its focus on mental processes that defy categorization and linear explanation. Analytic therapists tolerate uncertainty, find meaning in apparently disordered communication, and embrace the unexpected twists and turns that emerge from intimate attention to the ordinary complexities of everyday life. These are hallmarks of a psychoanalytic sensibility that spans various theoretical persuasions. Non-linear dynamic systems theory embodies the same sensibilities: It emphasizes such descriptors as pattern, complexity, flux and flow, the interplay of ambiguity and order, stability and instability, and the natural value of uncertainty and generative chaos. Although systems theory may appear esoteric and overly intricate, it can be approached in an intuitive, experience-near way so as to offer a language and an imagery that underlie everyday clinical thinking. Its metaphors and aesthetics can help analysts become more precise, spacious, and immediate about basic assumptions that tend to be taken for granted. In addition to tracing this conceptual path, this paper provides a brief account of the history of nonlinear thinking in psychoanalytic theorizing and offers clinical examples.
The central thesis of this paper is that grand theories of development are alive and well and should be paramount to those interested in behavioral intervention. Why? Because how we think about development affects how we approach treatment. Here I discuss the central concepts of a new theory of development – dynamic systems theory – to highlight the way in which a theory can dramatically alter views of what intervention is all about. Rather than focusing on one root of maladaptive behavior such as biological predispositions, environmental causes, or motivational states, dynamic systems theory presents a flexible, time-dependent, and emergent view of behavioral change. I illustrate this new view with a case study on how infants develop the motivation to reach for objects. This example highlights the complex day-by-day and week-by-week emergence of new skills. Although such complexity presents daunting challenges for intervention, it also offers hope by emphasizing that there are multiple pathways toward change.
The article opens with a fairly detailed overview of the research on nonlinear dynamic systems, deterministic chaos, and complexity theory – referred to collectively as complexity theory. The second part of the article is aimed at applying this research to an interesting discussion that has developed in the psychoanalytic literature regarding the fundamental nature of the self as either singular or multiple. Chaotic systems (a class of nonlinear systems) exhibit staggering variability, sensitivity, and adaptation in response to perturbation (in the form of sensitive dependence on initial conditions), while also demonstrating an enduring and distinctive coherence and continuity in their overall organization (in the form of strange attractors). As such, chaotic systems are useful in conceptualizing how relatively healthy people remain recognizable (or in character) in the midst of their variability, multiplicity, and change. By contrast, pathology of the self from the perspective of nonlinear dynamic systems is characterized by the repetitive, periodic and self-same quality of mental states.
In this memorial essay, the professional life and work of Emmanuel Ghent are discussed and assessed. His work in establishing the relational track, his multidisciplinary interests, some influences on his life and thought, the impact of Eastern philosophy and its system of practice and thought are briefly reviewed. Emmanuel Ghent's writings – his seminal papers on masochism, on relational perspectives, on paradox, and on motivation are discussed. Ghent's commitment to change, to uncertainty, and to supporting the generativity of students, analysands, and colleagues is noted.
Emmanuel Ghent, referred to with fondness as >Mannie,< is remembered for his capacity for sensitive attention. A brief moment shared listening to music serves as a point of departure for a series of reflections on Mannie's love of music and psychoanalysis, his commitment to change, and how his ideas about surrender shaped that commitment and continue to influence the analytic community. In his musings on Mannie's thesis concerning submission and surrender, the author considers how Federico Fellini's ideas about availability can add texture to Mannie's ideas about surrender. The essay closes with a return to the author's experience of the way in which Emmanuel Ghent embodied his credo.
This paper is an effort to describe and express and the tension between the observing mind and the >wisdom mind,< which has its taproots in the deep and unformulated experience of connectedness. Nominally about the process of writing as a psychoanalyst, it is more like my personal >Credo< in relation to the work of psychoanalysis, the work of writing, and the work of living with contradictions – life. In it I try to bring together disparate reflections, to illustrate in the writing itself the process of making >many into one.< Because so much of this essay relates to themes in Mannie Ghent's work, including his work on surrender and his >Credo,< it seemed to be appropriate to offer it to readers of this issue dedicated to his memory.
The author presents an intense exploration of damage, disappearance, masochism, surrender, control, and faith in a single case. The patient experiences her damaged and disappearing self beyond anything anyone can relate to. She connects to a paper by Emmanuel Ghent that seems to address those more intact than she, yet feels tantalizingly close to his concerns. Ghent's paper refers to her therapist, and through it she peeps into her therapist's soul and the hell of wondering if damage she knows can be shared.
This paper begins an examination of the complex relationship between psychoanalysis and Buddhist psychology and the practice of meditation. It describes in a series of episodes the ordeal of one patient during a Buddhist meditation retreat. She is asked during the course of the teachings to confront her own inevitable death, and in so doing finds herself simultaneously enduring the agony of a psychic death or collapse originating in earlier trauma. The narrative and subsequent discussion, using the language of psychoanalysis, aim to capture the conflictual yet generative aspects of the interplay between these two invaluable disciplines.
This paper explores the influence of Indian philosophical and spiritual thought on the psychoanalytic contributions of Emmanuel Ghent. The Indian intermingling of lower and higher, sensual and spiritual, and erotic and enlightened creates an alternative model to the hierarchical Western Platonic notion of sublimation as embraced by Freud. The author discusses an elaboration of the Indian position in Ghent's work on surrender and in his explorations of the contributions of D. W. Winnicott. In particular, this author posits that the Indian concept of the relationship of tapas, or restraint, to kama, or desire, influenced Ghent's thinking on the therapeutic action of psychoanalysis.
Thinking Differently Principles of Process in Living Systems and the Specificity of Being Known
(2005)
Therapeutic impasses in contemporary psychoanalytic treatment: Revisiting the double bind hypothesis
(2005)
This commentary focuses on how psychoanalysts may theorize the therapeutic action of reading and hearing poetry. It is argued that poetic action is a densely layered one- and two-person process that achieves its psychological effects by potentiating the mental space that is >thirdness,< in Jessica Benjamin's (2004) lexicon. Beginning with ideas about how poetry works on a single subjectivity, Goldner then considers the complex intersubjective and mutative processes that are set in motion when an analyst reads a poem to a patient. Building on Bollas's (1987) construct, the >transformational object< and on Ogden's (1998, 1999) and Akhtar's (2000) theories of poetic action, the author proposes that poetry can be usefully understood as a >transformational third.<
The paper by Barbara Pizer is discussed in terms of the analyst's use of the self. An important element in the use of the self in the psychoanalytic situation is the analyst's deeply personal, unique guiding spirit or muse. Poetry acts as a muse for Pizer. In this context, the historical romance between poetry and psychoanalysis is discussed. A successful poem can strike an immediate resonance with the known but inchoate and unarticulated experiences of the reader or listener. Like a dream, a poem can stimulate inquiry without footnotes, citations, or metapsychology. But unlike what Freud believed, poets do not have easy access to psychological insights. Pizer uses poetry in the consulting room to >construct, deconstruct, and then construct again.< Her refusal to make such use a technique or method is supported with two illustrations from Orfano's own clinical work.
Theory and change. Commentary on Morris Eagle's >enactments, transference, and symptomatic cure<
(2005)
The author posits that Pizer's use of both narrative and lyrical style is not typical in psychoanalysis, whose scholarly tradition tends to favor a denser, more academic style of writing. The ways in which psychoanalysts read these two forms of writing are mirrors of one another. Both kinds of reading are forms of discipline both forms of writing are necessary in psychoanalysis. The author also writes that Pizer's >nonanalytic third< does not have to be a >good< thing like a poem it can be almost anything important to the analyst. The nonanalytic third is a soulful metaphor that can be used to create alternatives to rigid experience. Because rigidity in psychoanalytic relatedness is usually the result of problematic unconscious involvements between analyst and patient, the nonanalytic third can be significant in the negotiation of enactments.
This author describes how poetry infuses her way of thinking, feeling, and writing and her way of working analytically. She introduces the concept of a nonanalytic third – the analyst's personal, intimate, and substantially abiding relationship to some body of experience unrelated to materia psychoanalytica. She posits that this nonanalytic third, the nature of which is unique to each analyst, constitutes a source of enrichment, texture, and dimensionality as well as personally compelling metaphors that the analyst may offer to the patient as other-than-me substance and a placeholder for cultivating the potential in the discourse of analytic potential space, in addition to serving as a facilitator and comfort for transition when the analyst must recognize and promote the necessary ending of an intimate analytic relationship. Using Stephen Mitchell's notions of intersubjectivity and also using the analyst's and patient's separate role responsibilities in the creation of a context for the absence of conscious intentions, the author develops her concept of the nonanalytic third and the particular contribution of poetry to clinical process. These ideas are illustrated with a detailed case example of an unfolding analytic process that includes an e-mail exchange at the time when a shocking form of nonanalytic third appeared – September 11, 2001.
In their commentaries, Sandage and Frommer each describe ways in which forgiveness may be intrinsic to the therapeutic process. But their papers also point to one of the great difficulties of promoting forgiveness as the goal in either theater or therapy, which is that the need to control the healing process can actually impede that process. This reply examines how that need may have undermined the writing of The Laramie Project, and it suggests that, in order to help audiences and clients find true forgiveness, playwrights and analysts may need to relinquish their own righteousness.
This author examines the concept of forgiveness as a psychological construct. He argues that it is an error to conceive of the capacity to forgive in exclusively intrapsychic terms, pointing to the mutual influence of psychic and interpersonal experience in the struggle to forgive. He suggests that we can meaningfully consider the psychic challenges involved in any instance of forgiving only when we can fully understand the relational context in which the wrongdoing has taken place. The author then considers the concept of forgiveness when applied to hate crimes in general and Matthew Shepard's murder in particular, exploring some psychic alternatives to forgiveness that may be useful in thinking about the human struggle to resolve the mental anguish and desire for revenge that can threaten to undo us. He argues against an agenda-based approach to psychotherapeutic treatment that is biased toward encouraging forgiveness and seeing it as an indispensable component of psychological health. If forgiveness is to function as a viable psychological construct with real healing potential in human relationships, psychoanalysts must work to free it from its moralistic and religious moorings.
Stephen Wangh's insightful article, >Revenge and Forgiveness in Laramie, Wyoming< invites a psychoanalytic contribution to interdisciplinary dialogue on violence, revenge, and forgiveness. This author suggests that one strength of Wangh's perspective is his attention to the interplay of systemic and intrapsychic dynamics, which offers a needed corrective to dominant individualistic perspective in psychological and clinical literatures on forgiveness. He notes that Wangh does not clarify a particular definition of forgiveness or an approach to interdisciplinary dialogue. This commentary outlines a linguistic approach to the definition of forgiveness by drawing on three semantic domains of meaning (forensic, therapeutic, and redemptive or sacred). The author suggests some areas of rapprochement between the construct of forgiveness and psychoanalytical theory across each of these semantic domains and briefly illustrates the role of hermeneutics in interdisciplinary dialogue.
This author posits that, perhaps because of its religious implications, psychoanalysis has historically avoided speaking of forgiveness, although playwrights have often depicted forgiveness as a psychological mechanism that can help resolve cycles of anger and revenge. The Laramie Project (Kaufman et al., 2001), a play about how a U.S. town deals with a murder and its aftermath, provides an example of the way in which forgiveness offers an exit from vengeance. The play points to both the positive and the negative roles that religious ideas play in human actions. At the same time, however, the play itself avoids some of the painful processes that enable human beings to locate forgiveness. This paper draws on psychoanalytic literature, social commentary, and plays by Aeschylus and Shakespeare to demonstrate how the mechanisms of forgiveness operate. In conclusion, it suggests that although enabling the psychological processes of forgiveness can be extremely difficult, ignoring these processes may be life-threatening.
The Use of Metaphors in the Service of the Therapeutic Alliance and Therapeutic Communication
(2005)
The Nature of Dreams
(2005)
Mental pain is a common concern of psychoanalysts in their professional life. Combining her clinical experience with previous contributions by others, the author presents a personal overview of the patient-triggered mental pain of the analyst. Countertransference is considered to be the major source of the analyst's work-derived mental pain. This type of mental pain is not to be avoided or discarded by the analyst. Rather, the analyst will benefit from tolerating and even welcoming professional mental pain: in most cases, mental pain will bring with it rich clinical material that, upon interpretation, will help him or her to offer previously intolerable contents back to the patient in a transformed version that now becomes acceptable. The analyst's mental pain may emerge in his dreams; clinical examples of this phenomenon are presented. It is suggested that there is an increased chance of the analyst undergoing mental pain when treating patients suffering from severe psychopathology, and a clinical case is reported to illustrate this assertion. The author proposes that a lifelong effort is to be expected from analysts in terms of enhancing their threshold of tolerance to professional mental pain. In situations of mental pain, analysts must be particularly aware of the need to modulate their interpretations before transmitting them to the patient. The capacity of analysts to transform their mental pain (Ta, according to Bion) will depend on the plasticity of their container functions, the quality of their transformation abilities and, in particular, their threshold of tolerance to mental pain.
The existence of man is distinguished by its split state: man stands in the middle of life yet still has an awareness of his own death. He has to compensate whatever is missing in him naturally at the societal level, created as culture, and at the individual level through creativity. Rank investigated the human 'creative drive', the anthropological aspiration to express oneself in creative works, and to overcome the fear of death with its help. Freud admired poets and artists, whose achievements he could not psychoanalytically access, but he considered science superior to the harmless and na ve arts. There are two anthropological radicals: premature birth and the consciousness of death. Freud's massive fear of death made it difficult for him to acknowledge the problem of death appropriately. In Rank's concept, the development of human creativity contributes towards the fear of death being alleviated so that the knowledge of death can be integrated into life; creativity belongs to the fundamental opportunities of man that may enable him to find a way through neurosis. Failure is as much a part of life as is creativity: those who do not experience and accept life in its tragic dimension are denied creativity. Only a creative person who accepts his partial failure finds the strength to continue to be creative without his imperfect work leading to the ritual repetition of the same thing again and again, that is, getting stuck in recidivism.