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This paper is a meditation on the interpenetration of mental and physical, particularly architectural, place. Its premise is that the relationship between person and place is transitional, ever in flux, person continually defining place into a continuous reality, and reality perpetually placing person. Further, this interchange occurs against the backdrop of an inconceivable void whereby the very terms of the interchange can be nullified. Such a void is unconscious and outside in the sense that it is outside what can be known. The matter of opening the inside to the outside becomes an endeavor shared by psychoanalysis and by architecture, notably sacred architecture. The exchange between inside and outside is considered using as examples the body, Freud's office, Disneyland, and the cathedral. Implications are extrapolated as to the provisional nature of the self.
A Contribution to the Settlement of the Historical Antinomy between Conflict and Defects in the Self
(1999)
Inquiring about the origin of mental distress from a relational point of view, the author focuses on the debate between conflict and structural defects, in order to overcome the dichotomy between the two different perspectives. According to the doctrine of defects in the self, which is based on certain Object Relations Theories, pathology is caused by faulty or inadequate caregivers. The doctrine seems too simplistic, because the child is thought of as completely passive. According to the relational viewpoint in psychoanalysis, the development of the subject takes place in a mutual conditioning process between the subject and the environment, which has to be better conceptualised. Defects in the interactive relationships with the primary caregivers, viewed as a failure in the relationship, create in the child a decompensation, which makes it withdraw from the relationship. In order to open itself to the relationship again, as a primal objectual need, the child builds up a pattern of response, which allows it to negotiate it again. Making use of the research on the first phases of development of R. Emde (psychoanalytic trend), C. Trevarthen (interactive-cognitive trend) and K. Kaye (child psychology), the author argues that the adherence to the structured response pattern leads to a conflict between the structured self image and any other potential different way of seeing oneself. Through a clinical vignette the author will demonstrate how this may lead to a non-cohesiveness of the self, viewed as an inactivation of the subject's developmental possibilities.
Action in connection with the therapeutic process is often equated with acting out. The subtle behaviour that belongs to ?the complicated system of transmitting and receiving unconscious signals? (Sandler), with which the patient attempts to make the analyst behave as the object of transference or to fulfill an unconscious desire, is also described as acting out or micro-acting out (Treurniet). This fine-grained action, however, means nothing; it is not symbolic or communicative action. Its intention is, rather, to trigger effects and induce interactions. It occurs not only on the side of the analysand but also on that of the analyst, and is part of the unconscious communication in the therapeutic process. Presented here are some of the various interactive ways and means with which the analyst is prompted into unconscious action and certain, unnoticed, ways in that he turn ?treatsfithe patient. The analyst's action responses can bear the character of interpretations with which he may unintentionally reveal how he regards the behaviour of the patient.
The forming and early development of the Swedish Society for Holistic Psychotherapy and Psychoanalysis is described. The influence of the personal background of those who formed the society, the general zeitgeist in which the society unfolded and the specific circumstances in the field of psychotherapy and psychoanalysis in Sweden at the actual time is paid attention to. The significance of Dr. Harold Kelman as a supervisor and teacher during the forming years is underlined. The forming of the International Federation of Psychoanalytic Societies (IFPS) is mentioned as an important matrix for the growth of the society.
This article, which analyses a crime that took place in the city of Brasilia in 1997, is based on two separate and correlated hypotheses. Firstly, this crime reveals a fact about psychic structure: the >real< dimension irrupts through acts. Therefore, psychoanalytical practice must contemplate the >real< dimension. Secondly, we would like to pose two questions. Is it necessary for today's psychoanalysts to be aware of and involved with contemporary events? If the analyst ignores modern dialectics, what kind of symbolic involvement can he establish with the lives of the people he analyzes? Being committed to contemporary symbolic culture signifies that we must relinquish the comfortable division between good and evil. Acts of violence, performed by human beings, necessarily indicate both >enjoyment< and >truth<. In the symbolic dimension, we understand and comprehend; in the symbolic dimension, we are reasonable. But, not all acts fall within this pacifying register. If we consider these two aspects: on one hand, the analyst's responsibility to the patient, in regard to symbolic commitment and, on the other hand, the irruption of violent and senseless acts, this would mean that as analysts, we find ourselves lacking a certain neutrality, contrary to the position defended by some analysts.
Using a naturalistic design, 44 patients in psychoanalysis were examined with regard to qualitative and quantitative outcome of therapy. The results were compared with those from 56 dynamic and 164 inpatient therapies. Comparison of symptoms, diagnoses, and motivation prior to therapy led to the conclusion that the patient groups treated within these settings differed greatly. For this reason randomisation appeared to be an inadequate strategy for comparing groups in different therapeutic settings. Using different outcome criteria, it could be demonstrated that psychoanalysis patients on the whole attained good therapeutic results. The outcomes were the best in comparison with the other two therapy categories investigated. The use of different outcome criteria and observer perspectives (patient and therapist) led to therapy results with clear-cut differences. In the patient view, the main effect was cessation of psychosomatic, anxiety- and depression-related symptoms. The therapists furthermore reported clear-cut changes in the scales depicting relationship variables. The study presents success rates obtained on the basis of different outcome criteria and discusses them with special emphasis on the methodology of recording outcomes. The paper concludes by making recommendations for psychoanalysis studies yet to be planned.
Masochistic fantasy staging can be seen as a creation of the ego in order to compensate for a psychic structural deficit that stems from being deprived of sufficient empathetic mirroring in early childhood. It consists in the inability to establish an internal empathetic object as a stable psychic structure. Using case-studies vignettes, it is shown how as a result struggle for empathy can become the central live theme and coincide with ?perverse? masochistic fantasies. After a short review of the most important traditional attempts to interpret masochism, the author delineates the communicative meaning of masochistic fantasies, which are composed of the complementary roles of the sufferer, the tormentor and the spectator. By this means the patient creates an inner scene which is apt to serve as a mirror for the experience of psychic pain and to represent the preverbal childhood trauma in a symbolic way. During analysis, this inner scene is shifted to the therapeutic relationship where different roles are kept ready for the analyst: the sadistic adversary; the unobtrusive witness of psychic pain and the role of an answering, reacting object. The relevance of these roles in therapy is examined. It is also shown how by somatisation of psychic pain the struggle toward empathy can be transferred to the stage of somatic medicine with the risk of provoking there a reaction referring solely to the body of the patient.
IFPS-Is there a Difference?
(1999)
This paper tries to answer a question about the difference between IFPS and other psychoanalytical institutions. The author states that there is a linkage between the ethics of psychoanalysis and the ethics of the institution. The ethics can not be represented by rules or standards of prerequisites, but by creating a space where the unconscious as desire, singularity and difference takes place. The bureaucratic organization and the hierarchy in the categories of members of IPA institutions goes straight against the transgressor experience of the unconscious. The training analysis under such conditions leads to an identification process with the training analyst, giving as final result standardized, homogeneous, obedient analysts. The author describes a new experience in the training of analysts in his institution without any kind of interference from IFPS. Finally, he concludes that differences exists between the two institutions and that they are mainly due to the identification process typical for IPA and the process of ''choice'' in IFPS.
The author looks into the issue of interpretation and traces its evolution both from mere opinion, and from the point of view of the historical development of hermeneutics. In supervision interpretive dissonance may occur at several levels starting with the patient himself as well as his >gatekeepers<, and going up to the supervisor. The relationship between interpretation and supervision is examined in this context, taking into consideration the subjective and intersubjective levels of scientific inquiry. Supervision enhances the complexity of interpretation by introducing yet a third subjectivity that questions the supervisee's interpretation. This has advantages and shortcomings, as supervisors are not always aware that it is ultimately in the supervisee-patient situation where hypotheses are tested and confirmed. Theory alone cannot supersede the intersubjective situation. It is pointed out that psychoanalytic curricula should be reexamined in order to include semiotic science and its application to interpretation and supervision.
Kohut's major contribution to psychoanalysis was in his systematizing a clinical approach to disorders of the self. Kohut's theoretical innovations, however, are often misunderstood for a variety of reasons, as evidenced in Dr. Meronen's paper, >The Return of Narcissism: Heinz Kohut in Historical Context<. Through redressing some of Dr. Meronen's misunderstandings of self psychological theory and his subsequent conclusions, I attempt to clarify in this discussion Kohut's sweeping technical innovations and the theory from which they are derived, all of which are reflective of Kohut's fundamentally personal vision of the essential nature of man.
Since its formulation by Bleuler in 1911, the generalisation of the term >autism<, mainly due to its use by Kanner in 1943 and its remake by authors of Kleinian inspiration, implies problems which mislead us, blurring our perception and understanding of clinical realities. Our psychoanalytical possibilities can be enlarged by a clear knowledge of the history of psychoanalysis, a dynamic approach to psychiatric classification and to problems related to our conception of the setting. On the basis of a case history the author shows how a child and its family worked through major autistic symptoms and proposes new approaches to some psychoanalytical concepts.
The pleasure of thought during the session is an intellectual feeling, that can take several forms at different moments during the analyst's thought process. The following should be distinguished: the disruption introduced by interpretative interference, which by underlining an unconscious element, upsets the conscious logical flow of the analysand's speech; finding the key-word or the overdetermined image which springs to the mind in the same way as a poet finds a rhyme; the resurgence of a memory, once evoked and subsequently forgotten again by the analysand, which imposes itself with quasi hallucinatory sharpness in the analyst's representative space; the experience of co-thought, either on one particular occasion related to a specific representation, or as a complement, accompanying the analysand's associative process.
Freud published his >On Narcissism: An Introduction<' in 1914. The writing has many levels, including, among other things, Freud's criticism of his former colleagues, Adler and Jung. Psychoanalysts received the essay with reservations. Ernest Jones, among others, expressed his concerns in his history of psychoanalysis. The aim of this study is to place Heinz Kohut's ideas about narcissism into the context of the history of ideas. Especially, the paper explores, at a theoretical level, the status of the castration complex both in self psychology and Freud's essay as well as seeks reasons why the discussion on narcissism should be continued.