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Befreiung zum Sein
(2001)
The way in which the parent’s conscious and unconscious fantasies are trans-mitted to the infant has been an intense object of study. The author discuses the influence of those parental mental representations on a child, even after the mother’s death, specifically focusing on the consequences of the child’s unresolved bereavement.
This essay explores the sometimes uncanny quality of unconscious experience and unconscious communication that often characterizes life in psychoanalytic relationships. As Ferenczi noted some 70 years ago, the psychoanalytic relationship may >significantly promote the development of subtler manifestations of receptivity.< Special qualities of unconscious receptivity and deep points of contact in the psychoanalytic relationship are explored, with reference to the history of psychoanalytic ideas (e.g., Freud, Ferenczi, Singer, Loewald, Symington) and to findings from other fields such as contemporary quantum science. Clinical vignettes are provided to illustrate such phenomena.
This essay elaborates on some of the ideas set forth in >It Takes One to Know One< in response to Peter Shabad's and Paul Williams's commentaries on that paper. In particular, the distinctions between process and mental structure and between unconscious process and relationship are explored and developed. An attempt is made to clarify some of the similarities and differences between British object relations perspectives and some U.S. relational ideas as they apply to these distinctions and their relevance to clinical technique.
The Complexity of Evil
(2001)
A Fond Farewell
(2001)
Erich Fromm, la psicoanalisi, gli psicoanalisti, Published on the website www.erich-fromm.it.
(2001)
The current emphasis on identifying empirically supported treatments (ESTs) can distort psychotherapy research by emphasizing the investigation of treatment in an atypical context, with atypical patients, in a contrived treatment contract. An alternative to comparing the efficacy of different types of therapeutic techniques for treating focal symptoms is to seek to identify the factors that facilitate therapeutic change in various types of therapeutic intervention. The emphasis on identifying ESTs also has the potential for distorting clinical training and limiting clinicians' ability to develop the skills necessary for becoming effective therapists.
Psychoanalysis and Epistemology: the Interrelation between Clinical Work, Culture and Metapsychology
(2001)
The paradigmatic theory of modern epistemology holds psychoanalysis in its scientific statute. Even if there is no explicit epistemology in the Freudian writings, it is undeniable that the genesis of psychoanalysis has a rigorous dialetic between theorization and clinical observation. Metapsychology is an organized and consistent set of concepts, capable of explaining and coordinating the analytical experience. It is through metapsychology that clinical work encounters the possibility of universalization, while metapsychology finds the possibility of fulfillment in clinical work. Clinical experience also confirms the interrelation between psychopathology and culture. Modern times have brought about new versions for psychopathological symptoms, which, in turn, have special effects on the narcisistic personalities and the manifestations of anxiety, giving place to different neurotic configurations.
Reply to Hainer and Weishaus
(2001)
When Freud began his professional career, psychotherapy was already an established practice, standing upon the theory of ideogenesis, according to which certain motor symptoms were caused by ideas . This theory offered the rational ground for psychotherapy: if a symptom was provoked by an idea, it was possible to undo it by finding and erasing this very idea. Freud developed this theory into the model of unconscious ideas and into the technique of >interpreting the contents<. Whereas the later discoveries of resistance, transference, and character structure, should have promoted a break with the ideogenetic model, Freud never gave up the erroneous assumption that behind an action there was an idea, which had to be captured if one wanted to stop the action. This assumption was questioned again and again during the interminable controversy over the relative importance of remembering and experiencing: by Ferenczi and Rank in the Twenties, Alexander in the Fifties, and Gill in the Eighties, when they tried to shift the focus from remembering to experiencing, in order to make psychoanalysis an effective psychotherapy. Today, the view that what organizes our actions is stored in the form of >ideas< is no longer accepted by the scientific community. Instead, we speak of >operative models< and implicit or procedural memories.
The psychoanalyst's ethics at issue – referred to a paradigm of complexity in the postmodern age – is to affirm as a fundamental value the recognition of determinism of unconscious desire, which implies a renunciation to any exercise of power, even the power of influence that can guide and support. Intending through interpretation of the partial truth of desire to be accomplished as a process that subverts the subject's relation with its own history, psychoanalysis, as it undoes the imaginary fixations of the subject, cannot predict the >politics< of the unconscious desire. Nor can it confront the possibilities of decision and choice of a relative and finite freedom. Using the interpretative elaboration of an intersubjective field of values, the psychoanalytic practice reveals the limits of a knowledge restricted by the context where the interpretation takes place. It differentiates between deciphering and decoding by emphasizing the attribute of the uncognoscibility of the unconscious Thus it reveals the cryptogram, a cipher designed as an ambiguous puzzle that is not exhausted by interpretation as a symbolic act, and it refers to the unrepresentable and the inaccessibility of the real.
Reply to Spezzano
(2001)
This is about a small boy and his >imaginary< friend, who happens to be a gorilla – a friend the boy considers very real indeed. It is also about the fact that no part of the self, including every child's relationship to his own >gorilla,< is ever >reasoned< out of existence. It becomes, instead, >not really real,< because it has had to be relegated to >not really me< in order for the child to preserve his attachment bond with significant others. However, it will continue to make its presence known through being relationally enacted, dissociatively, in ways that eventually become repetitious enough and painful enough to bring the child (now an adult) into our office years later. As analysts, our job at that point becomes one of trying to restore the connection between the little boy and his gorilla in the face of intense pressure by the now >grown-up< patient to keep them apart and to discourage the therapist from trying to bring these old friends back from dissociation into the >really real.< The source of therapeutic action that allows this reunion to take place is discussed conceptually and described in clinical vignettes.
I offer the view that the symptom picture found in most patients with eating disorders, as well as in the symptomatology of many other so-called difficult patients, is the end result of prolonged necessity in infancy to control traumatic dysregulation of affect. I propose that the central issue for an eating-disordered patient is that she is at the mercy of her own physiologic and affective states because she lacks an experience of human relatedness and its potential for reparation that mediates self-regulation. She is enslaved by her felt inability to contain desire as a regulatable affect and is thus unable to hold desire long enough to make choices without the loss of the thing not chosen leading to a dread of self-annihilation. Trauma compromises trust in the reparability of relationship, and for symptoms to be surrendered, trust in reparability must be simultaneously restored. Because felt desire is the mortal enemy of an eating-disordered patient, this fact becomes a central dynamic in the analytic field, leading analyst and patient into a struggle over who shall hold the desire and whether the issue of control over food is allowed to become a subject for negotiation. I discuss the inevitability of the analyst's own dissociative reactions in response to the patient's internal war over desire and control, and the different types of interpersonal enactments into which an analyst is drawn. In this tension, as illustrated through clinical vignettes, analyst and patient slip in and out of a constantly shifting array of self-states and thereby have an opportunity to coconstruct a transitional reality within which the patient's impaired faith in the reliability of human relatedness can be restored, and eating can become linked to appetite rather than to self-protection.
La enseñanza del amor
(2001)
This article describes the experience of dying, shared in the therapeutic process by the psychoanalyst and patients suffering from incurable or terminal illness. Chronic illnesses and the possibility of death places the patient and the family in a disturbing and stressful situation, that requires not only continued medical care but also sensible listening to the patients’ needs, to prevent harm-ful and unnecessary interventions. When disease is in an advanced stage, and death is inevitable, high technology medicine must be avoided and the intimacy of the person must be the highest and most important issue in the relation. The clinical material of this article describes the psycho-social stages that patient and family go through during the process and also how understanding hope could be a universal clinical strategy that creates a therapeutic bond, offering the patient and the analyst the alternative of meaningful experiences.
The health service systems of the Western world are transforming rapidly. These systems are under pressure from an increase of new biomedical possibilities for intervention in the processes of the human body, from the rising expectations of the public, and from demographic developments that are leading to an increase in the number of elderly people in the Western world. Parallel to these changes on the macro level there are major changes on the micro level, that is, there is a search for methods to manage the basic way that the health system functions. In short, the financing, organization and practice of medicine will be changed considerably over the next 5-10 years. In the search for a harmonious development in this field the concept >evidence< must be seen in a broad perspective that encompasses, among other things, the increasing multidisciplinary nature of modern medicine.