We, as analysts, are constantly confronted with the paradox between the infantile as a phantasmal reconstruction based on the patient's fantasies and recollections, and childhood as a period of maturation and development, where it is impossible to avoid a reference to chronology. Although many authors have indicated that psychoanalytic practice is based on the traumas, conflicts, wishes and fantasies of the child within the adult, what happens when the patient is a child and not an adult? This paper discusses psychoanalysis with children from a structural point of view, asserting that psychoanalysis can only be beneficial to a given child if it considers his potential as a subject, promoting a change of places within the family structure. In other words, if it helps the child to displace himself from the position as an object of parental discourse, facilitating the access to his own desire.
Children in Violence
(1996)
Multiversal truths
(1996)
Geheimnisse des Wassers
(1996)
Marco Bacciagaluppi attempts to place Fromm's clinical approach within the spectrum of current psychoanalytic models of therapy. Based on Goldberg, Hoffman, and Hirsch, among others, Bacciagaluppi distinguishes three therapeutic stances: the observationalinterpretative stance, in which the analyst observes conflict and limits his participation to providing insight; the >participation with< stance of empathic immersion into the patient's experience; and the >participation in< stance, which recognizes the analyst's inevitable involvement in (and likely reenactment of) the patient's problems. Bacciagaluppi notes several discrepancies in Fromm's approach, including the discrepancy between Fromm's advanced theoretical position, which places him in the >participation in< position, and his emphasis on insight, which places him in the observational-interpretative position. A second discrepancy is that between Fromm's emphasis on providing insight and the importance he attributed to providing a new experience for the patient. Bacciagaluppi concentrates primarily on the second discrepancy and illustrates Fromm's approach using a published case he supervised. – In the clinical case, Fromm is empathic and respectful toward the young woman's traumatic history and emphasizes, like Ferenczi and Bowlby, the importance of real-life experience. At the same time, Fromm states that the essence of analytical cure resides in the conflict engendered by the meeting of the rational and irrational parts of the personality. Bacciagaluppi points out that Fromm at times seems to downplay the importance of the analyst, and lists the personality of the analyst as just one of seven other factors that are important in clinical work. In discussing the importance of new experience in therapeutic change, Bacciagaluppi points out that new experience is seldom new, and that we often find the existence of >weak precursors< (Hoffman 1983) that provided in childhood a supportive and positive experience for the patient. Bacciagaluppi points out that we should be grateful for these weak precursors, and need to be modest in our claims to success as healers, as we are often building on the positive contributions of others who preceded us. Bacciagaluppi offers two clinical examples that illustrate the weak precursor concept. The first example exemplifies a case in which the history of a weak precursor was present from the onset of the therapy. In the second example the existence of a positive figure in the patient's life emerged only much later in the therapy.
Many patients manifest a desire to help the analyst. This is usually understood as being derivative of defensive aims or in the service of other primary motivations. This paper argues for the developmental and clinical importance of primary altruistic aims, which are often warded off by the patient because of his or her fears of exploitation or rejection. Several pathogenic beliefs and varieties of psychopathology result from the failure of the patient's caretakers to allow the child to contribute to their welfare, to >take< the child's >help.< Similarly, some patients require tangible evidence that they are having a positive impact on their analyst. Ordinary >good-enough< technique often reinforces the patient's view that he or she has nothing to offer. A full appreciation by the analyst of the importance to patients of having their altruistic gestures and concerns recognized and accepted can open up possibilities for analytic progress and therapeutic growth. Various sources of resistance to and misunderstanding of these dynamics are explored, ranging from ethical concerns to certain traits that cluster in the personalities of analysts.