Is There Still Time?
(2002)
In order to discuss the depressive personality we have first to distinguish between this clinical entity and other types of depressive psychopathology that might also be chronic. The character traits and psychodynamics of the depressive personality confirm that there is a special group of patients, who belong to a depressive disorder continuum. The particular technical problems that depressive personality present are: (1) the inability to enjoy anything and the consequences of this on the therapist's experience and interventions, and (2) the negative therapeutic reaction which threatens the analytic process and the therapist's competence. If we combine transference/ extratransference interpretations with an >empathetic understanding< approach to systematic confrontation and interpretation, we can therefore justify the need for a slightly modified psychoanalytic technique in the treatment of the depressive personality.
Using a clinical vignette, in which self-disclosure appears as a starting point, the authors investigate the connection between method and techniques. As the recent literature on the subject generally maintains, the classical analysts' neutral position can no longer be accepted. Analysts are always fully engaged in the intersubjective relationship and pass their values on to their patients through their professional roles – which can be understood as self-disclosure in a wider meaning. However, self-disclosure, and in more general terms the analyst's participation in the process, need technical criteria of reference. By deepening the relationship between method and techniques, established by Rapaport, the authors maintain that method is determined by theory and in turn gives meaning to techniques. As a consequence, techniques play a minor role with regard to theory and method. The opening of psychoanalysis to the relational perspective is bringing about the decrease of technique as an absolute value in favour of a greater self-awareness of the analyst who, following the method related to his/her theory will be able to better cope with techniques.
Promotion and Protection of the Rights of Children. Impact of armed conflict on children. 78 pp.
(2002)
Much contemporary analytic writing is focused on the intersubjective >space< between analyst and analysand. This article focuses on a different area of analytic subjectivity and intersubjectivity – on the implicit rules that guide psychoanalytic thought and discourse, which have not received the kind of critical scrutiny as our explicit theories. The paper describes five problematic aspects of this implicit grammar and corresponding ways of refining it: articulating conceptual multiplicity where we often use unitary constructs (such as the unconscious or the therapeutic action of psychoanalysis) specifying mechanisms rather than causally ambiguous descriptions (such as two unconsciouses talking to one another) and conditional rather than blanket statements avoiding using terms in overdetermined ways that lead to theoretical imprecision and confusion of theory and metaphor exercising greater caution in the use of developmental constructs and analogies, particularly from infancy and rethinking the nature and presentation of evidence in psychoanalytic discourse.
Two central questions raised by Spezzano's commentary have to do with the extent to which we seek objectivity in psychoanalytic theory and practice, and the extent to which one or another set of methods (e.g., clinical observation) is adequate or optimal for generating that knowledge. A discipline and treatment devoted to understanding subjectivity is nevertheless devoted to objective knowledge about a patient's subjectivity, defenses, and so forth and requires valid theories to guide exploration, inference, and intervention. Seeking objective knowledge does not require a naïve empiricism ignorant of the limits of objectivity. We would do well to use multiple methods to learn about how the mind works and what leads to therapeutic change.
Review Robert F. Bornstein and Joseph M. Masling (Eds.): Empirical Studies of the Therapeutic Hour
(2002)
There has been little or no research on the establishment of infant moods or the mechanisms underlying them. One reason may be our difficulty in entertaining the idea that there are affective processes in infants that have long-lasting organizing continuous effects. It is this possibility that is considered in this paper. I attempt to address the questions of how moods are created and what some of their functions are. My model of moods is that infants have long-lasting (e.g., hours, days, and even longer) mood states. Mood states are dynamically changing yet distinct assemblages of affective behaviors. Mood control processes are modified by affective input from others. Thus moods are cocreated by the interplay of active, self-organized, biorhythmic affective control processes in the infant and the effect of the emotions expressed by others on mood control processes. In recognition of the importance of Sander's thinking to this work, I have named one of these processes the Sanderian Affective Wave. Mood states organize behavior and experience over time. Critically, moods serve an anticipatory representational function by providing directionality to an infant's behavior as he >moves< into the future. Thus they provide continuity to infants' experiential life. Furthermore, moods fulfill the Janus principle of bringing the past into the future for the infant, but as a noncognitive/symbolic/linguistic process – that is, as a purely affective–memorial process. Moreover, I believe that consideration of the development of moods opens the way for thinking about dynamic conflictual emotional processes in infants. Lastly, thinking about moods has important implications for understanding the development of pathology and for therapy.
In discussing the complexities and dialectical tensions inherent in the relational point of view, this commentary seeks to alert the reader to the simplifying dichotomies that can lead theory and clinical practice to be hostage to ideology. In exploring those dichotomies and their problematic implications for our work, emphasis is placed particularly on the nature of what constitutes evidence for our formulations and conclusions the different blind spots that different epistemological positions are designed to alert us to or, at least partially, to overcome the ways in which our efforts to transcend those blind spots often themselves create new blind spots the relation between insight and new relational experience the ambiguities associated with the (highly important but at times conceptually perilous) distinction between the one-person and the two-person models and the tensions between the need to hear patients in a fashion that is affirming and accepting and the equally important need to hear their fervent wish to change what they also want to have accepted. Many of these tensions and complexities are examined in the context of a critique of Bion's claim that analysts should be >without memory or desire.<
Self psychology: Today
(2002)
In this commentary it is appreciated that in his approach Safran avoids some of the common pitfalls of brief therapy discourses, namely, the extremes of therapeutic grandiosity and therapeutic nihilism. Instead, seeking to maintain a >middle way,< he strives to balance the pragmatic and instrumental aims of time-limited psychotherapy with an appreciation of the existential and human dimensions of the therapeutic encounter. Safran also works to extend the full implications of relational theory to the theory and practice of brief psychotherapy. In this effect he relies on the contributions of constructivism, interpersonal psychoanalytic theory, and relational clinical theory. In this commentary some tensions and even contradictions are remarked upon between certain aspects of Safran's approach and the fundamental assumptions of relational theory. A tension is noted between the instrumental aims of brief therapy and Safran's goal of radical openness to patients. The importance of therapist decentering is acknowledged, along with paradoxes in the use of the concept of metacommunication. Finally, a question is raised as to the compatibility of empirically oriented approaches to psychotherapy research with the philosophical assumptions of a two-person psychology.
Historicity, Humility, and the Analytic Exercise Reply to Commentaries by Drs. Palombo and Horner
(2002)
In Ferenczi's idea of identification with an aggressor we can distinguish two sides. One is what we might call an interactive tactic or a social strategy, which is used in upsetting or unbalanced relations of power in order to forestall lack of control, fear, and the like. This is the side that is explored in great detail by Jay Frankel. The other side consists in a intrapsychic change, which flows from severe trauma. The specific effects of the latter are described by Ferenczi as dissociation/fragmentation of the personality, sequestering of the trauma, emotional abandonment, and isolation. Elsewhere, Ferenczi refers to this as a form of psychic self-mutilation.
Commentary on Eric M. Plakun >Jihad, McWorld and Enactment in the Postmodern Mental Health World<
(2002)
This paper discusses the impulse to psychic and political splitting with its consequent political demonization of the other when emotional helplessness and fear cannot be metabolized. I argue that it is through an acceptance of our feelings of helplessness that we are in a position to experience the subjectivity of the other and to begin the process of political discourse.
This paper examines a state of fear aroused in the analyst during a session. I suggest that the fear arose from the attempt to enter the patient's mental state – a state that was unfamiliar to the analyst. In entering what was essentially psychically foreign territory, I terrified myself with a version of the patient's experience.
Reply to Stern.
(2002)
Instead of dichotomizing psychic life as either intrapsychic or interpersonal, I suggest we think in terms of a continuum of self-experience from the most private or interior to the most public or exterior. I articulate four >domains< – phenomenologic, intrapersonal, interpsychic, and interpersonal – that constitute this spectrum of self-experience. Each domain lends a specific quality to one's internal life, and together (but in varying proportions) they constitute the psychic dwelling place unique to a given individual. This article illustrates how the variability among our patients in their habitual dwelling places may explain their diverse responses to differing analytic stances, interpretive approaches, and indeed, different analysts. A clinician's awareness of his or her own personal proclivity toward a more interior or more exterior orientation helps promote optimal contact with the patient's psychic life.
This paper is a response to a critique by C. Brooks Brenneis of the written account of a clinical enactment that featured countertransference dissociative effects in treatment and in supervision. The response focuses on the need to analyze power in overlapping clinical dyads, the effect of transpersonal transmission of affect states and disavowed experience, and the relation of power dynamics to transference and to meaning making.
This essay combine's clinical vignettes and an edited set of postings on an Internet discussion of the events of September 11 and their aftermath. I raise questions about how a psychoanalytic inquiry coordinates with other ways of understanding terrorism and trauma and about our complex relationships as clinicians, citizens, witnesses, and actors. I consider the movement from shock to reaction to analysis. I try to weave critical analysis and affective processing I was interested in the difficulty of clinical work in conditions of ongoing uncertainty and shared anxiety. These observations are interspersed with clinical material from experiences in the consulting room and in volunteer work.
In this commentary I address the functions of gender and of bodily state as a way of managing memory, affect, and interactions. I consider the status of alters as narrative or as historical truths. Graham Bass's case illuminates problems and potentials of touch and the inevitability of intersubjectively constructed enactments.
The author argues that terrorism aims to obliterate the conditions that allow us to distinguish between situations of safety and situations of danger. If we are unable to make that elemental distinction, we necessarily doubt the value of our own immediate thoughts, perceptions, and ideas. Psychoanalytic theory offers an alternative to immediacy. I think psychoanalytically about an object, one must identify with it and doing so to think of what the terrorists meant we must find a way to identify with them. This entails consciously working against the strong appeals of disidentification. Disidentification is the precondition for pitilessness and, as such, is the precondition for limitless activities directed against the objects of our hatred. It matters what the terrorists meant, then. It matters that we find our way to identifying with what we think they meant. The moment we conclude that it does not matter, we loosen the checks on our own capacities for terrorizing.
Walter Bonime: 1904-2001
(2002)
Despite the recent interest in erotic countertransference and self-disclosure, little has been written about these phenomena when both analyst and patient are the same gender. Since homoerotic feelings can surface in any treatment, regardless of the participants' sexual orientation, this may well be a phobic avoidance that restricts many treatments, as well as our profession. I propose that the analyst's awareness of homoerotic feelings in the countertransference – including struggling with ways to express them – ultimately can create an atmosphere of safety. I offer an extended case example of one man with whom I colluded to ignore frightening aspects of his sexual fantasies. It was only by using my erotic countertransference, especially at a charged and pivotal moment, that I was able to help the patient begin to integrate split-off aspects of his sexuality.
Commentary on Bernard J. Paris: Daniel Deronda and Gwendolen Harleth: A Therapeutic Relationship
(2002)
When both therapist and client share a traumatic event, there are multiple levels of vulnerability to traumatization for the therapist. Our personal vulnerability is not only a backdrop for our clinical work but also an acknowledged fact in many therapeutic relationships, a situation that changes the frame of the work. In addition to clinical challenges, shared trauma increases a therapist's vulnerability to vicarious traumatization VT is defined as the negative transformation of the therapist's inner experience as a result of his or her empathic engagement with and responsibility for a traumatized client. Emphasizing the importance of awareness, self-care, meaning, and community, the article summarizes important steps to anticipate, address, and transform the therapist's experience of vicarious traumatization.
As a way of integrating emerging knowledge of biological systems, developmental process, and therapeutic process, we identify principles in the process of exchange between organism and its context of life support that are present at all levels of complexity in living systems, from the cellular to the organization of consciousness. These principles range from specificity, rhythmicity, recurrence, and pattern to coherence, wholeness, and a relative unity in the organization of component parts. By proposing that these principles are also governing the exchange between mother and infant as they negotiate a sequence of essential tasks of adaptation, or >fitting-together< between them over the first years of life, the author suggests that the biological level becomes integrated with the developmental. A sequence of adaptive tasks extends from specificity of recognition in the newborn state, to recognition of inner awareness, purpose, and intention – shaping conscious organization. The bridge to the therapeutic level is constructed as therapist and patient build increasingly inclusive and coherent moments of recognition between themselves at the level of conscious organization, which act as corrective experiences, bringing the patient's own senses of >true self< and of >agency-to-initiate< to new levels of validity and competence.
In this article I describe an approach to brief psychoanalytic treatment that is consistent with many of the key principles of the relational tradition. In this approach the treatment process is conceptualized as an ongoing cycle of therapeutic enactment, disembedding, and understanding, enactment and disembedding. Particular emphasis is placed on the use of countertransference disclosure for purposes of facilitating the collaborative exploration of relational scenarios that are being unwittingly enacted between patient and therapist. The influence of the brief time frame on the treatment process is explored and differences between the current approach and other approaches to brief psychoanalytic treatment are examined. A case is presented to illustrate the approach, and a number of questions are explored regarding the nature of change in short-versus long-term treatments.
In this article I. Reply to commentaries on my paper, >Brief Relational Psychoanalytic Treatment.< The discussants have raised a number of thoughtful and discerning questions that provide me with an opportunity to clarify some of the major points in my original article and to elaborate on certain issues in greater depth. Some of the key questions addressed in my. Reply are: (1) How is the tension between the emphasis on openness and receptivity and the time-limited nature of treatment negotiated in Brief Relational Psychoanalytic Treatment? (2) To what extent does an emphasis on openness and receptivity interfere with the process of establishing a productive focus? (3) How does one resolve the tension between the desire for change and the need for acceptance? (4) What are the therapeutic implications of regarding the mind as embodied and what roles do emotion and bodily felt experience play in the change process? In addition, I take up the question of whether or not adhering to a constructivist epistemology is incompatible with conducting and valuing psychotherapy research.
This paper addresses how to be an available and responsive therapist to a controlling and narcissistically vulnerable young girl. It presents an overview of the treatment relationship and specific vignettes from sessions. The paper describes an impasse that posed a quandary: how to find a balance between staying in control of the treatment while being responsive to the kind of object the child needs the therapist to be – being empathic without being intrusive – and meeting her aggression without getting into a power struggle. The author discusses how asserting her subjectivity by playfully role-playing aspects of the patient, by spontaneously using humor, and by surviving her destructiveness allows the treatment to move forward. Trial and error, reflection on practice, and informed intuition contributed to the author's understanding of the child and of the transference. Various theoretical perspectives influenced the work.
When we feel overwhelmed by an inescapable threat, we >identify with the aggressor< (Ferenczi, 1933). Hoping to survive, we sense and >become< precisely what the attacker expects of us – in our behavior, perceptions, emotions, and thoughts. Identification with the aggressor is closely coordinated with other responses to trauma, including dissociation. Over the long run, it can become habitual and can lead to masochism, chronic hypervigilance, and other personality distortions. But habitual identification with the aggressor also frequently occurs in people who have not suffered severe trauma, which raises the possibility that certain events not generally considered to constitute trauma are often experienced as traumatic. Following Ferenczi, I suggest that emotional abandonment or isolation, and being subject to a greater power, are such events. In addition, identification with the aggressor is a tactic typical of people in a weak position as such, it plays an important role in social interaction in general.
To anchor my response to three issues raised by Berman and Bonomi, I rely on Ferenczi's concept of >traumatic aloneness.< First, I agree with both discussants that identification often has constructive and life-creating effects, but I suggest that it may generally arise in response to (sometimes hidden) anxiety, specifically about separation or aloneness. Second, I examine what Ferenczi termed >introjection of the guilt feelings of the adult< – trauma victims frequently feel that they are >bad< – and explore this complex feeling both as an effort to preserve others as good objects and as a way to protect oneself from a frightening aggressor. Finally, I consider the idea that trauma leads to partial psychic death. While I think it is clinically dangerous to assume that trauma can cause the actual, permanent destruction of part of the personality – this assumption can lead to unwarranted therapeutic pessimism – trauma certainly often carries the subjective experience of partial death or dying. The therapeutic effort to undo dissociations and achieve authenticity and intimacy can be thought of as rediscovering one's aliveness through the process of sharing it with someone.
In this commentary I examine homoerotic countertransference within the context of the analyst's erotic countertransference experience. Discussing male analysts' difficulties receiving and experiencing homoerotic feelings as a function of their dominant erotic desires (along gender lines), I propose both cognitive and affective explanations to illuminate their defenses. I suggest that Sherman's erotic countertransference is best understood when viewed as a product of both induced feelings emanating from his patient's dissociated sexual abuse and also his anxiety and shame in response to particular relational configurations with his patient that arouse him. Finally, I point to the site of the transgressive as integral to the construction of erotic desire and suggest shifts that need to occur in the erotic subjectivity of this dyad so that the treatment can move forward.
Symposium on gender and the analytic relationship. Sex, gender, and the analyst's subjectivity
(2002)
Director's paper calls our attention to the lack of attention to addiction in the relational literature. Clinical case studies of patients with chemical dependency may provide a window into the complexities of the mind – body connection in psychoanalysis. The transference – countertransference dimensions of the treatment of addicted individuals offer the therapist a privileged glimpse of the patient's internal object relations and thereby enable the therapist to gain greater understanding of the patient's characteristic problems in relationships with others.
Some thoughts on self-disclosure and the danger-safety balance in the therapeutic relationship
(2002)
The letter to the September 11, 2001 terrorists is analyzed in an effort to understand the state of mind of a religious suicide-killer. The letter has a solemn, serene, even joyful tone that is infused with love of God and a strong desire to please Him. The author suggests that incessant incantation of prayers and religious sayings while focusing attention on God led to a depersonalized, trancelike state of mind that enabled the terrorists to function competently while dwelling in a euphoric state. On a psychodynamic level, the theme of father–son love is used to explain the ecstatic willingness of the terrorists to do what they saw as God's will and to follow transformations from (self) hate to love (of God), and from anxiety and discontent to the a narrowly focused fear of God. Homoerotic bonding and longing, coupled with repudiation of >femininity,< are explained as an inability to >kill< the primal murderous father, as the mythological Primal Horde. Freud's description of sons' (group members') hypnotic love for their father leader (which, that when not reciprocated, turns into masochistic submission), seems pertinent for the understanding of the sons' >return< to an archaic, cruel father imago. >Regression< to the father is compared with classical maternal regression.
Language and the Nonverbal as a Unity: Discussion of >Where Is the Action in the >Talking Cure<?
(2002)
This paper addresses the postmodern critique of unified-self theories that argues that the self is not unified but multiple, not a static entity but in constant flux, not a separate center of initiative but intersubjectively constituted. The author proposes that there are two kinds of division in self-experience: the dissociative divisions of multiple-self theory, and a division, akin to the divisions between Freud's structural agencies, between what are here termed the >intersubjective self< and >primary subjective experience.< In contrast to dissociated self-states, which occur in different moments in time, these two dimensions of self-experience occur simultaneously indeed, what is most important about them is their relationship. The author suggests that it is this intrapsychic relationship, as it occurs in a given psychological moment, that determines the qualities of self-experience that are emphasized in unified-self theories: such qualities as cohesiveness versus fragmentation authenticity vs. falseness vitality versus depletion optimal versus nonoptimal self-regulation and agency versus feeling one is at the mercy of others. Furthermore, a major organizer of the intersubjective self is early identifications, especially >identifications with the other's response to the self.< The implications of these concepts for therapeutic action are discussed and illustrated with an extended account of an analytic case.
The discussions by Pizer and Brandchaft are so different in tone and focus that I answer them separately. Pizer invites dialogue about the relationship between identification and dissociation, which I pursue further with him. I then briefly consider his therapeutic model, which emphasizes the negotiation of paradox, in the light of the identificatory divisions in self-experience that my model highlights. Finally, I address his concern that I bypassed the >crunch< of the repeated relationship in the case example of Jonathan. I argue that the stance I ultimately adopted was my way of bridging the paradoxes presented by Jonathan. Brandchaft couched his discussion as a dismissive attack, prompting me to defend myself while trying to engage in a dialogue about substantive issues. I respond to his criticisms regarding my epistemological position, my use of the concepts of identification and projective identification, and the process and outcome of my treatment of Jonathan. The bottom line is that the differences between our perspectives are not, as Brandchaft contends, those between an objectivist, causally >unidirectional< model and an intersubjective one, but rather those between two versions of intersubjectivity.
This paper is a response to an essay by Drew Westen. The author agrees with many of Westen's arguments about problems in the psychoanalytic literature and adds that the psychoanalytic literature has always been a problem for psychoanalysis. If we think of psychoanalysis as an ongoing experiment, then its >trials< are all the analytic sessions that have been conducted. Our >literature< has never systematically drawn on those. Westen critically scrutinizes certain habits that, in his view, haunt our literature, but that we do not explicitly note or disown as conceptual contrivances we mean to get rid of, while they are often misguiding clinical thinking and practice. I suggest that a fascinating question riding below the waves of Westen's paper is why patients and analysts accept this situation. I suggest that we all treat psychoanalysis as wisdom, art, relationship, skill, and something other than the application of established scientific findings because we recognize and accept it as that kind of human activity. It is unclear if patients care whether or not their analysts are scientists, but it is clear that analysts are not optimistic about sifting the research literature and finding clear clues to more effective clinical thinking, work, or writing.