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A brief history of my tears
(1992)
A case report: Part I
(1992)
A case report: Part II
(1992)
A Contribution to the Method and Purpose of an Analytical Social Psychology [originated 1937]
(1992)
Clearly recognized by researchers in the field as one of the major long-term sequelae of childhood trauma, discussion of the process of dissociation remains embedded in the classical psychoanalytic literature and is not often referred to in contemporary psychoanalytic writing. This article attempts to update the definition of dissociation in accordance with contemporary research on traumatic stress and posttraumatic stress disorders and to demonstrate the manifestations and impact of dissociative phenomena in the psychoanalytic treatment of adult survivors of childhood sexual abuse. Several points are emphasized: (1) treatment of the adult survivor of childhood sexual abuse involves recognition of the simultaneous coexistence and alternation of multiple (at least two) levels of ego organization (2) at least one level represents, in split-off form, the entire system of self- and object representation, including unavailable, affectively loaded memories and fantasied elaborations and distortions originating in the traumatogenic abusive situation and (3) there is present a kaleidoscopic transference-countertransference picture that shifts illusively but can often be understood as based on the projective-introjective volleying of a fantasized victim, abuser, and idealized, omnipotent savior.
A Plea for Sincere Lies
(1992)
A Poetics of Change
(1992)
A paradox must be accepted on its own terms, without resolution, and, at the same time, valued as a pointer to a new level of comprehension. Many of the phenomena we encounter in our psychoanalytic work have simultaneously a quality of remarkable similarity and radical, even contradictory, dissimilarity. The apparent paradox is ultimately resolvable by an understanding of the process that underlies and therefore relates the phenomena. The twin dangers that inhere in dealing with paradox and process are, first, the inability to accept the paradox, that is, a premature resolution of it, and, second, a clinging to the paradox so as to avoid articulating the process that would allow one to climb into a new grasp of reality. Among the questions touched on in this paper are: How can there both be and not be a baby inside? How can there be both need and no need at the same time? How can there be both destruction and transcendence in the same moment?
Ferenczi (1988) described the procedure of mutual analysis, in which the patient and analyst switch roles for part of the time in the analysis. This procedure allowed patients in stalled analyses to make progress and enabled the analyst to overcome certain countertransference blocks but was ultimately rejected for certain drawbacks. Working in the countertransference is a modification of mutual analysis that retains some of its benefits and eliminates some of its drawbacks. In such work, the psychoanalyst's personality and psychodynamics become the center stage of the manifest content of the session the analyst avoids interpretations of the transference and, instead, elicits the patient's detailed understanding of the analyst's psychodynamics. The analyst does not, however, generally volunteer his free associations or facts about his own life. This process allows deep work with patients with a predominance of projective identification. Working in the countertransference may be preferred in cases of severe psychopathology to other procedures for its lessening of the frequency, severity, and persistence of transference psychoses. The procedure is also a useful supplement to transference analysis with neurotic patients, for whom it can break through blocks caused by anxiety-laden issues or countertransference impediments.
The negotiation of paradox may be considered as an essential vehicle of the therapeutic action of psychoanalysis. The paradoxes inherent to the psychoanalytic experience are considered here with particular reference to Winnicott's writings, which abound in, and require, paradox. These paradoxes are evident in the following juxtapositions: the subjectively conceived object versus the objectively perceived object personal isolation versus relatedness ruthlessness versus concern and dependence versus independence. In analysis, the framework for the transitional area of illusion is maintained through a continuing intersubjective process of negotiation, by which analyst and patient seek to straddle the paradoxes of their many-layered relationship. This ongoing process of negotiation carries both the potential for structure building and the delicate hope for a reworking of repetitions in the transference-countertransference construction. Exploration of these issues includes consideration of the analyst's and patient's coauthorship of metaphorical communications and a definition of the analyst's neutrality in terms of his responsibility to preserve the area of illusion for ongoing negotiation. Finally, detailed clinical material serves to illustrate the process of negotiation in the course of a treatment.
No single issue illustrates more clearly the interpersonal therapist's struggle between asymmetry and mutuality than countertransference disclosure. On a theoretical plane, all versions of interpersonal psychoanalysis share a comfortable tolerance for a central dynamic tension between the mutual influence of the participants and the asymmetry inherent in a relationship that emphasizes understanding the motivations of only one participant. This same marriage of concepts has, however, been a source of considerable confusion within the area of technique. The practitioner is charged with the technical implementation of the theory and must define the line between asymmetry and mutuality in everyday interactions with patients. Difficulty tolerating the ambiguity caused by the tension between asymmetry and mutuality results in the understandable urge to seek a definitive and unwavering position on countertransference disclosure. Dimensions of the therapist's struggle include complex decisions concerning the primary unit of study (patient or relationship), the sequence of exploring new and old object transference experience, the use of disclosure with or without concurrent understanding, an assessment of the patient's capacities to tolerate disclosure, and, lastly, the initiation and frequency of disclosure interventions. An integrative perspective on the tension between mutuality and asymmetry allows the dialectical relationship between these principles to reach a constantly evolving equilibrium unique to each patient based on the moment of clinical interaction.
How one thinks about the nature of what analysts know about themselves and their patients is said to have practical implications for the way analysts work. A social-constructivist view of the process is contrasted with both the objectivist perspective and what is termed the >limited constructivist< view. The latter, exemplified by Schafer, focuses only on the way theory affects interpretation. At the heart of the more thoroughgoing social-constructivist viewpoint is the notion that analysts cannot know the full meaning of their own behavior, both retrospectively (in the context of interpretation) and prospectively (in the context of deciding what to do from moment to moment). The model requires that analysts embrace the uncertainty that derives from knowing that their subjectivity can never be fully transcended. Nevertheless, this very uncertainty frees analysts to >be themselves< within the constraints of the purposes of the analysis. Analysts can now >speak their minds,< including expressing conviction about their points of view, even sometimes when they clash with those of their patients. Both uncertainty and conviction are present but have different meanings in constructivism than they do in >open-minded positivism.< In the constructivist view, what had been known before on the basis of theory, research, or cumulative clinical experience is not discarded rather, the authority of that knowledge is subtly diminished in proportion to a subtle increase in respect for the analyst's personal, subjective experience as a basis for what the analyst does or says. Several examples are given of the way this attitude can affect practice.
There is substantial and often heated debate concerning the true nature of psychoanalytic expertise. The position is taken that no such characterization will ever attain anything approaching universal consensus. Conclusions that are drawn concerning the nature of psychoanalytic expertise are unalterably influenced by underlying fundamental assumptions concerning emotional development, psychopathology (when that term is even used), and what is needed for useful change to come about. This paper explores the nature of psychoanalytic expertise as it is conceptualized and understood within the three models articulated by Mitchell (1988) that have dominated psychoanalytic theorizing: the drive-conflict model, the developmental-arrest model, and the relational-conflict model. Special attention is paid to considerations of asymmetry and mutuality in the analytic relationship.
Constructivist positions tend to emphasize the relativity of the unconscious to that which can be explicated in linguistically articulated, conscious experience. This notion emphasizes conscious creativity and change rather than unconscious repetition and resistance. The seemingly contradictory objectivist idea of the unconscious as a psychological system with its own integrity posits entities and forces that determine and shape behavior. This model of unconsciousness provides theorists a bulwark against reducing experience to purely social determinants. A dialectical view of the social-constructiviness of experience is suggested that links the concepts of absolute and relative unconscious together.
This paper describes how a patient's sensitivity to the counter-transference sparked a transference regression that generated insight about her core conflict: False-Self compliance at the expense of her needs for love, emotional support, and nurturance. My patient's regression was important, first, because it produced symptoms that dramatically illustrated to her how much self-denial she was willing to exercise to feel needed by others. Previously, such insight had not been effective because of the extraordinary secondary gains of her behavior. This time was more successful because of the ego-dystonic symptoms that developed, with intense shame and embarrassment. Second, the regression resulted in a transference dream that provided her with new insights into the anxiety she was warding off through False-Self compliance to the narcissistic requirements of her parents.
Throughout his working life Freud rejected the dualism of mind and body, which suggests that we can study people's thoughts, feelings, and relationships without taking into account the bodily contexts in which people live their lives. In his conception of the bodily origins of mental functioning, however, children are seen to be oblivious to their environments for a significant period in their early lives (the first 18–24 months). This conception is increasingly found to be untenable: current perspectives and observations both within and outside psychoanalytic psychology suggest that infants interact with their environments from birth. This paper attempts a model for an interactive perspective on the bodily origins of the mind. It proposes that from the beginning of life infant experience occurs in interactions. Because the mental and physical aspects of infant's experience are initially not differentiated, these interactions are absolutely body-bound. That nondifferentiation also results directly in the primitive experience modes Freud described as the primary processes. Development occurs by integration and differentiation. It leads to the transition, at 18–24 months, that Freud ascribed to the child's turn to the external world and to the testing of reality, the beginning of psychic conflict, and the relegation to the unconscious of unacceptable ideas, which in his view accompany it.