Mind and Brain in the 1990s
(1993)
Freud and Jung
(1993)
Beyond the inevitability of countertransference feelings is the question of countertransference enactments. From a two-person, participant-observer or observing-participant perspective, enactments are inevitable. The analyst becomes influenced by the patient (and influences the patient as well) and enmeshed in the patient's internalized interpersonal configurations. Analysis works not by avoiding such action but by analyzing from within the interactional system. Analysts who are different from one another become engaged in different ways, since the person of the analyst is a significant variable. This article, using case examples, explores two analyst-related variables, age and family configuration, to expand the examination of countertransference enactments and some effects on the analytic process.
Reply to the Commentaries
(1993)
Erich Fromm revisited.
(1993)
Mastery and guilt
(1993)
Boa and flowers
(1993)
Action and insight form an essential dialectic within the psychoanalytic process. Yet many recent psychoanalytic formulations, while emphasizing integration, have continued to view psychoanalytic and action-oriented techniques dichotomously. It is reasoned that certain behavioral-cognitive techniques that promote adaptive behavior can become an active part of an in-depth analytic experience, providing material for an exploration that results in new ways not only of relating but also of experiencing the self and others. Such an approach, while at times helpful to certain patients, can be counterproductive for others. An integrative approach is compatible with many recent psychoanalytic frameworks emphasizing a two-person psychology, but not with a one-person vision of the psychoanalytic situation in the two-person view, it is reasoned that an integrative approach is capable of maintaining the integrity of the analytic process. The outlined technique reflects a relational psychoanalytic orientation emphasizing internalized object relations, with the use of action-oriented techniques organized by the superordinate goal of modifying psychic structure, conceptualized principally in terms of self- and object-representations. Reasoning that this approach is congruent with certain theoretical contributions from Gill, Mitchell, Sandier, and especially Wachtel, among others, I state underlying assumptions of the approach, preliminary technical guidelines, and illustrative case material.
How People Get Better
(1993)
This paper considers, from a psychoanalytic point of view, work with urban poor patients. A previous attempt, from an ego psychological perspective, to adapt psychoanalytic theory and technique for work with such patients is reviewed. An attempt is then made to elaborate an object relations perspective, based largely on the work of Fairbairn. The two approaches are compared and contrasted, especially with respect to common problems that arise in work with this group of people, such as missed appointments, crises, and requests for >concrete< help. Finally, there is a review of how the structure and policies of the public clinics in which most poor patients are seen impact on analytically oriented work.
Play and Therapeutic Action
(1993)
The self-destructive subject: critical theory and the analysis of the unconscious and society
(1993)
Feelings of loss or abandonment, alternating idealization and disparagement of their wives, envy of their wives, and denial of limits imposed by their own sexual organization are regularly reported in explorations of men's disturbed reactions to their wives’ pregnancies. In women this pattern of reactions, directed by them toward men, has long been understood to reflect little girls’ responses to the recognition of their sex and gender limits. In men it has not been interpreted coordinately as a pattern of reactions to the recognition that the capacity to give birth cannot be theirs because they are male. Freud repeatedly raises this possibility, but he invariably rejects it as incompatible with children's early knowledge and beliefs. He seems implicitly to give it credence but he can find no way to integrate it into his profoundly phallocentric theory of sex and gender development. A differentiation model of gender development (Fast, 1984) suggests that penis envy and envy of women's childbearing capacities are the responses of girls and boys, respectively, to the recognition of their sex and gender limits. For men, the pregnancy of their wives is hypothesized to provide a powerful stimulus for the reemer-gence of sex difference issues. Support for this view is found in both clinical studies and explorations of men's reactions to their wives’ pregnancies in nonclinical populations. Some of these investigations suggest, moreover, that this reemergence offers men opportunities to reengage issues of sex and gender limits and move toward increasingly subtle and sophisticated resolutions of them during the period of their approaching fatherhood.
The Relationship between Formal Operations Cognition and Suitability for Psychoanalytic Treatment
(1993)
In this paper I reverse the more commonly posed question, how does the analyst's gender affect transference? Instead, I examine the implications of the analyst's view of the organization of transference in the analytic situation for understanding gender-salient transference formation. I suggest that the analyst's viewpoint on the organization of transference is focal in his or her conception of gender-linked transference themes. I demonstrate that even in the context of a shared theoretical outlook, variations in a one-person psychology perspective on transference entail contradictory findings. I discuss a reformulation of transference, utilizing the contribution of self psychology. It demonstrates a combined one-person, two-person psychology view applied to the organization of a two-dimensional transference. Gender-specific, object-related, and selfobject facets of the transference are codetermined by the patient's psychology and the current ongoing analyst-patient interaction. I contrast conceptualizations of gender-salient transference from within a continuum of a one-person psychology and from a combined one and two-person psychology view. I propose that a combined one- and two-person psychology view on the organization of a two-dimensional transference guides a more encompassing understanding of patients’ transference experience of analysts’ gender. In a clinical vignette I illustrate the application and clinical utility of this perspective.
Sex in a Confucian Society
(1993)
The hermeneutic turn in psychoanalysis may be less a move toward soft science than an attempt to address certain failures in the classical tradition. The latter has failed to convert Freud's many metaphors into anything like responsible science it has been unable to give up its fascination with Freud and move on to other thinkers and other points of view it has been unable to find an answer to the problem of secrecy and privileged access to clinical data under the heavy hand of theory, it has all but eliminated research from the psychoanalytic enterprise and finally, it has been unable to find a home for the Roshomon effect and the fact that almost everything worth looking at has at least two sides. Above all, psychoanalysis needs to recognize that our theory is often the projection of either our Zeitgeist or our personal history. Until we can make room for the problem of subjectivity in our theory-building, we will never be able to separate the singer from the song.
A challenge is offered to the characterization of psychoanalysis as suffering from potentially fatal epistemic flaws and needing to ground itself in the language of hermeneutics, neuropsychology, or infant observation in order to survive. Psychoanalytic truth is neither made up nor discovered. Psychoanalytic propositions are true in the important sense of being the most useful statements we can make right now about the nature and functioning of the human unconscious. Psychoanalytic theories evolve through rational critical discourse just as theories evolve in all fields of science and scholarship.
This paper argues that some forms of sadomasochistic fantasy and enactments can represent a developmental and therapeutic advance for some patients. Playful fantasies of dominance and submission, when enacted, function to reassure the patient that the other can survive the full expression and power of his or her sexual desire. Sadomasochistic scenarios can mitigate guilt and worry and free the patient for an experience of sexual ruthlessness. The apparent differences in the manifest roles of the man and woman in this situation are belied in a paradoxical way by underlying commonalities. A woman can use her consensually scripted domination as a reassurance that the man can withstand the full force of her excitement, and the man can experience his partner's excitement in submission as a condition of safety for the consolidation of his phallic strength. Two clinical examples illustrate these paradoxes and the affirmative dimension of certain kinds of sadomasochistic play. The suggestion is made that blanket critiques of sadomasochism as either perversion or misogyny are misguided and potentially repressive.
I present a case study in which the dramatic disappearance of the patient's chronic symptom of dyspareunia followed a critical episode in the treatment in which a core dynamic theme of defiance-punishment was enacted in the patient-therapist interaction. Symptomatic cure was not accompanied by the patient's explicit insight, but rather seemed to be a function of a complex process of test-passing and transference-countertransference enactments leading to the discorifirmation of a core unconscious pathogenic belief. Concepts of transference, transference cure, misalliance cure, and analysis of transference are discussed in the context of this case study.
An underlying premise of this paper is that human beings actively and purposefully impose meanings on their experiences of psychic injury and that these meanings then have important implications for character development. Specifically, the paper examines how individuals, in defensive reaction to psychic injury, may repress their >impossible-to-fulfill< wishes, only to find those wishes eventually reborn as needs. In this way, a person's oppressive cruelty to his own wishes gives rise to resentment, indignation, and entitlement, which, in turn, fuel the experience of need. While wish implicitly communicates a request to receive from another, need, with its vicissitudes of demand and urgency, may do violence to the free social discourse of giving and receiving. The interpersonal field of give-and-take may be so constrained by the circular compulsivity of mandated giving and entitled needfulness that it is emptied of any spontaneous desire. The differential impact of communicating needs and wishes on the wider social contract – of which psychotherapy is an influential constituent – is then addressed. The paper then discusses how need and entitlement may be manifested in the transference along a passivity-activity dimension and thus illuminate the theme of responsibility for the treatment. Finally, the view of need as an entitled demand for gratification is contrasted with a view of need as a fervent wish for recognition in conjunction with the process of mourning. Mourning is viewed as a process of reintegrating impossible-to-fulfill wishes for >what could have been< and relinquishing the necessity of their fulfillment.