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- 2005 (388) (remove)
In providing the background to a pivotal session, Stuart Pizer reveals his clinical work as an unsupervised neophyte, prior to his own analysis and analytic training. These early therapeutic efforts were flawed, leaving Pizer at times >grimacing with mortification 26 years after the fact.< But they were also extraordinarily helpful to the patient. Schaffer discusses the challenge of supervising similarly talented beginners: how does one teach psychoanalysis without desiccating a treatmen? How does one teach a relational approach, with no >basic model< and few rules, to a beginning analyst infused with an unformulated, yet often passionate, sense of what is >curative<? Pizer recognizes that were he to meet the same patient today, he would not conduct the same treatment. Now trained and analyzed, not to mention more cautious and >worldweary,< Pizer would not do what he did then. But what if he were the supervisor then? Schaffer concludes her discussion by asking Pizer how he, now a seasoned analyst, would supervise his early therapist self.
Stephen Wangh's insightful article, >Revenge and Forgiveness in Laramie, Wyoming< invites a psychoanalytic contribution to interdisciplinary dialogue on violence, revenge, and forgiveness. This author suggests that one strength of Wangh's perspective is his attention to the interplay of systemic and intrapsychic dynamics, which offers a needed corrective to dominant individualistic perspective in psychological and clinical literatures on forgiveness. He notes that Wangh does not clarify a particular definition of forgiveness or an approach to interdisciplinary dialogue. This commentary outlines a linguistic approach to the definition of forgiveness by drawing on three semantic domains of meaning (forensic, therapeutic, and redemptive or sacred). The author suggests some areas of rapprochement between the construct of forgiveness and psychoanalytical theory across each of these semantic domains and briefly illustrates the role of hermeneutics in interdisciplinary dialogue.
Freud's theory of melancholia has lately experienced a renaissance among those interested in the creative potentialities of the psyche. In this essay, I consider the ways in which melancholia can contribute to the actualization of these potentialities by preparing the ground in which inspiration can later take root. I also outline the circumstances in which the melancholy subject's refusal to abandon its lost objects represents an entirely valid response to loss. At the same time, I propose that if the subject is to develop an affirmative and imaginatively supple relationship to its psychic history, it must in the end move from melancholia to meaning production. Insofar as melancholia signals the psyche's inability or stubborn unwillingness to move forward, its powers by necessity remain dormant until the subject is able to exchange its sadness for the versatile meaning-making capacities of the signifier. I moreover argue that it is only when the subject is able to transcend its melancholia enough to begin to desire new objects that it can develop loving and responsible relationships with others – that it can begin to welcome others in their own terms rather than reducing them to its own narcissistic image.
Transferred fictions
(2005)
Neil Altman and Rachael Peltz suggest the relevance of psychoanalytic ideas drawn from the object relations tradition to understanding contemporary American social life. They see the denial of suffering and the projection of hostility in an increasingly individualistic culture as a >manic defense.< While sympathetic to this critique, this commentary raises questions about it. It argues that the object relations perspective is only one of several versions of psychoanalytic thinking. Psychoanalysis is neither value free nor committed to one set of values, but is rather a plural discourse within which moral and social differences can be explored. The paper suggests three ways for advancing the critical program set out by the authors. It recommends that clinical work be used as a valuable source of evidence of the consequences of social organization for personal lives, that arguments based on case descriptions of individual experience can be effective forms of public communication, and that the value of the >containment model< presented by Altman and Peltz needs to be demonstrated in practice as well as in theory, through psychoanalytic work both in and beyond the consulting room.
My response to the discussions is organized from an evolutionary perspective on the development of theory within psychoanalysis. After briefly stating the premises of the paper, I discuss each commentary. I experience Aron's discussion as more evolutionary than Benjamin's or Ellman's. It seems clear that we all have our own agendas. The reader is invited to try them on for size in the spirit of ongoing dialogue that characterizes this journal.
This paper has two purposes. The first is to elaborate compromise formation theory from an intersubjective perspective. The second is to explore the implications of this vantage point for our understanding of the modes of therapeutic action of psychoanalysis. I pursue the goals of this paper by outlining the essentials of compromise formation theory and by elaborating what I mean by its intersubjective dimension. Then I present and discuss analytic data to demonstrate the value of the theory for understanding aspects of mode of therapeutic action. Finally, I contrast this perspective with competing theoretical points of view.
Envy, Shame, and Sadism
(2005)
This case provides a delicate approach to vital purpose, unconscious pattern, and >emotion recollected in tranquillity.< The author defines, the >paradoxical analytic triangle< to which Pizer refers, as a human quality, an unprecedented level of understanding and comprehension, that lets analyst and patient recognize their own dependence on the object. In so doing, they both gain a quality of presence through recovering the projections that they have attributed to the object. Four aspects are considered important steps leading to this human quality within the analytic process: dissociation leading to impasse sensibility opening to countertransference recollection in tranquillity leading to self-reflexivity and the patient's >vital purpose< – the most salient aspect (the lighthouse) of the whole project.
Replying to eight commentaries on my paper submitted by readers of this journal, I address such disparate issues as matters of training and supervision, theories of regression, the analyst's self-states, the patient's vital purpose, complexities of doing for the Other, and the question of what needs to be spoken (interpreted, formulated, declared) explicitly between patient and analyst. I further explore the meaning of my stating to my patient that I would not hug her in our analytic work ahead. And I respond to questions regarding my concept of the paradoxical analytic triangle.
This author describes how poetry infuses her way of thinking, feeling, and writing and her way of working analytically. She introduces the concept of a nonanalytic third – the analyst's personal, intimate, and substantially abiding relationship to some body of experience unrelated to materia psychoanalytica. She posits that this nonanalytic third, the nature of which is unique to each analyst, constitutes a source of enrichment, texture, and dimensionality as well as personally compelling metaphors that the analyst may offer to the patient as other-than-me substance and a placeholder for cultivating the potential in the discourse of analytic potential space, in addition to serving as a facilitator and comfort for transition when the analyst must recognize and promote the necessary ending of an intimate analytic relationship. Using Stephen Mitchell's notions of intersubjectivity and also using the analyst's and patient's separate role responsibilities in the creation of a context for the absence of conscious intentions, the author develops her concept of the nonanalytic third and the particular contribution of poetry to clinical process. These ideas are illustrated with a detailed case example of an unfolding analytic process that includes an e-mail exchange at the time when a shocking form of nonanalytic third appeared – September 11, 2001.
The article opens with a fairly detailed overview of the research on nonlinear dynamic systems, deterministic chaos, and complexity theory – referred to collectively as complexity theory. The second part of the article is aimed at applying this research to an interesting discussion that has developed in the psychoanalytic literature regarding the fundamental nature of the self as either singular or multiple. Chaotic systems (a class of nonlinear systems) exhibit staggering variability, sensitivity, and adaptation in response to perturbation (in the form of sensitive dependence on initial conditions), while also demonstrating an enduring and distinctive coherence and continuity in their overall organization (in the form of strange attractors). As such, chaotic systems are useful in conceptualizing how relatively healthy people remain recognizable (or in character) in the midst of their variability, multiplicity, and change. By contrast, pathology of the self from the perspective of nonlinear dynamic systems is characterized by the repetitive, periodic and self-same quality of mental states.
Two ways of being
(2005)
In this article I maintain that, as a society, we are lacking a basic commitment to the social equivalent of Winnicott's >environmental provisions.< Though we live in a democracy with certain inalienable rights, we have not instituted a system of governing authority to protect those rights. Instead, the needs of the market have taken precedence, overriding the needs of the populace. I believe that psychoanalysis can be used to inform political and social policies by underscoring the importance of the environment (familial and societal) and of the responsible agents (parents and governmental institutions) to provide an environment that fosters growth and creativity. I suggest that one internal, psychic response to the lack of a system of governance that guarantees the provision of basic environmental needs is the proliferation of manic defenses. Compulsive consumption, a behavior our market heavily relies upon, rates as one of the many socially sactioned manic attempts to ward off the pain and anxiety associated with both the absence of a containing governing authority and the loss of basic provisions including health care schools safe water, air, and food energy and other needed resources. A composite clinical picture will be presented to illustrate the manifestation of manic defenses. These defenses will also be discussed in relation to the changing role of work in this society.
The paper by Barbara Pizer is discussed in terms of the analyst's use of the self. An important element in the use of the self in the psychoanalytic situation is the analyst's deeply personal, unique guiding spirit or muse. Poetry acts as a muse for Pizer. In this context, the historical romance between poetry and psychoanalysis is discussed. A successful poem can strike an immediate resonance with the known but inchoate and unarticulated experiences of the reader or listener. Like a dream, a poem can stimulate inquiry without footnotes, citations, or metapsychology. But unlike what Freud believed, poets do not have easy access to psychological insights. Pizer uses poetry in the consulting room to >construct, deconstruct, and then construct again.< Her refusal to make such use a technique or method is supported with two illustrations from Orfano's own clinical work.
Proof of Life: A Discussion of Dori Laub's >Traumatic Shutdown of Narrative and Symbolization.<
(2005)
Stuart A. Pizer's fascinating article explores through a relational lens analytic impasse, and its manifestation through transference and countertransference love. How this love is demonstrated (or not) and the ways in which we provide for our patients will have profound effect on the process (and progress) of any treatment. But, too often, reluctance to >do for< our patients compromises our ability to provide what may be needed in any given moment. Perhaps an expansion of the >doer – done to< dyadic paradigm into a >doer – done for< model might allow more analytic leeway and more possibility of growth within our patients.
This paper revisits the case of >Karen< (>Whose Bad Objects Are We Anyway? Repetition and Our Elusive Love Affair with Evil,< PD 14/6) eight years after the time period described in the earlier paper, and uses this case material as a backdrop for discussing a relational reformulation of the termination process. The paper posits that an analysis conducted around a model of mind that holds multiple self–other configurations as the fundamental organizing structures needs to take these self–other configurations into account in ending an intensive treatment. Therefore termination becomes, from this perspective, a series of endings between multiple self–other dyads that have emerged during the treatment process. Extended clinical material is provided to illustrate this point of view.
The progress of psychoanalysis and psychotherapy depends on our capacity to study, in a scientific manner, the process of therapy. Since a study of this kind involves charting the waxing and waning of something as elusive as the sense of personal existence, the task has, in the past, been seen as virtually impossible. However, words, or more particularly, the way words are used, manifest such shifting states. Sophisticated linguistic analyses are available, providing the means to conduct these necessary studies. This article suggests that an ongoing sense of personal existence, which William James called >self,< is multilayered, in the manner of the poetic, and that indices of such layering will reflect beneficial change. The description of this zone of experience, which might be called the synchronic, depends on contributions from Marcel Proust, Virginia Woolf, Henri Bergson, and Ferdinand de Saussure. An illustration of the value of a consideration of the minute particulars of the therapeutic conversation is given by means of extracts from therapy sessions seven months apart.
Response to Sandra Buechler.
(2005)
The two papers on the psychoanalytic treatment of addiction are important contributions and provide us with newly organized tools and techniques. Emphasizing the dissociative reactions in this area also highlights the issues we encounter in the analysis of the addictive type of personality. Both the transferences and the countertransferences need special attention because they are difficult for every patient and analyst. Thus we are alerted to these individuals' great neediness and dependency and their desperate defenses against confronting the core problems. After all, their personalities are dominated by their need to escape, deny, or block their lifelong misery. Hence, the burden is for the analyst to deal with his or her own feelings of boredom or helplessness, and the challenge is to handle the patients in a supportive and yet interpretive way in the interactional and relational cooperation. These new insights and review of old principles will reward the reader.
The thoughtful discussions of my paper by Alan Schore, Wilma Bucci, and James Fosshage raise important considerations about the relationship between theory, research, and the micromoment interactions constituting the activity of psychoanalysis. For the opportunity afforded by their contributions, and to Psychoanalytic Dialogues for publishing our exchanges, I express deep gratitude. I am initially impacted by the appreciation shown by my colleagues for the approach I am illustrating to clinical attention and its value for an expanded and, in certain ways, revised scope of psychoanalytic activity. In particular, I am appreciative of the ways that each commentator has taken up my emphasis on expanding psychoanalytic attention beyond symbolic pathways of exchange and has further contributed to understanding how this can occur. As part of a consideration of points of convergence and difference between us, I address how such convergences and differences shape both the values and pitfalls of comparisons across research, theory, and practice.
Wish, Need, Drive: Motive in the Light of Dynamic Systems Theory and Edelman's Selectionist Theory
(2005)
Limitations to the process of symbolization for communication in psychoanalytic work are considered as the basis for an expansion of clinical attention to include embodied experience as a source of unconscious meaning. The displacement effect of language and the futility that language meets, as description of lived experience, are key points recognized in the contributions of Daniel Stern and Jacques Lacan. Irwin Hoffman's critique of assumptions underlying Freud's technique for analytic work are reviewed as a point of departure for recommending a relational approach to analytic attention expanded with an emphasis on micromoment-embodied communication in addition to symbolized communication. A clinical narrative is offered, highlighting the rhythms of movement between embodied and verbally symbolized communication as a basis for constructing unconscious meaning. The implications of this approach are summarized for expanding analytic attention to include registers of communication in addition to the verbal symbolic.
Emmanuel Ghent, referred to with fondness as >Mannie,< is remembered for his capacity for sensitive attention. A brief moment shared listening to music serves as a point of departure for a series of reflections on Mannie's love of music and psychoanalysis, his commitment to change, and how his ideas about surrender shaped that commitment and continue to influence the analytic community. In his musings on Mannie's thesis concerning submission and surrender, the author considers how Federico Fellini's ideas about availability can add texture to Mannie's ideas about surrender. The essay closes with a return to the author's experience of the way in which Emmanuel Ghent embodied his credo.
Stephen Wangh's thoughtful essay on revenge and forgiveness in Laramie, Wyoming, raises a number of questions about the role of psychoanalytic theory in shaping as well as reflecting culture. The events that took place in Laramie cannot just be material for psychoanalysts to examine and interpret. Rather, Laramie is a mirror that forces us to reflect on ourselves and our own contribution to the killing of Matthew Shepherd because he was gay. Psychoanalysts have described gay men as immature, predatory, paranoid, narcissistic, sadistic, masochistic, and pitiable. As the major discourse on gender and sexuality in the Western world, we have been and remain an influential part of the larger context in which gay men become the targets of hatred disguised as moral outrage. Rigid gender prescriptions add to the problem by pathologizing some groups and idealizing others. Psychoanalysts need to acknowledge this homophobia and its consequences directly and begin to rethink theory along more intersubjective, less value-laden lines. Some parallels to the South African truth and reconciliation movement are suggested.
The author discusses papers by Director and Burton, placing their work in a context of contemporary psychoanalytic models for understanding addictive behavior. Whereas early psychoanalytic models stressed drive theory and a topographic model of the mind, the contemporary models discussed here emphasize themes of dissociation – integration, helplessness – omnipotence, self-organization, and relational therapy. The author considers how these modern themes resonate with psychoanalytic formulations of addictive vulnerability that have considered disturbances in affect recognition/tolerance, self-esteem, relationships, and self-care. The author concludes by suggesting that the dyadic paradigms advanced by Director and Burton likely have implications for psychodynamic group treatments.
Book Review : Roger Frie, editor, > Understanding Experience: Psychotherapy and Postmodernism.<
(2005)
In this memorial essay, the professional life and work of Emmanuel Ghent are discussed and assessed. His work in establishing the relational track, his multidisciplinary interests, some influences on his life and thought, the impact of Eastern philosophy and its system of practice and thought are briefly reviewed. Emmanuel Ghent's writings – his seminal papers on masochism, on relational perspectives, on paradox, and on motivation are discussed. Ghent's commitment to change, to uncertainty, and to supporting the generativity of students, analysands, and colleagues is noted.
The case of Peter.
(2005)
Therapeutic impasses in contemporary psychoanalytic treatment: Revisiting the double bind hypothesis
(2005)
This commentary focuses on how psychoanalysts may theorize the therapeutic action of reading and hearing poetry. It is argued that poetic action is a densely layered one- and two-person process that achieves its psychological effects by potentiating the mental space that is >thirdness,< in Jessica Benjamin's (2004) lexicon. Beginning with ideas about how poetry works on a single subjectivity, Goldner then considers the complex intersubjective and mutative processes that are set in motion when an analyst reads a poem to a patient. Building on Bollas's (1987) construct, the >transformational object< and on Ogden's (1998, 1999) and Akhtar's (2000) theories of poetic action, the author proposes that poetry can be usefully understood as a >transformational third.<
This commentary on papers by Neil Altman and Rachel Peltz argues that while the type of political culture in which one lives has a significant impact on the practice of psychoanalysis, no direct line can be drawn from psychoanalytic theory to any particular political persuasion. It is one thing to argue that psychoanalytic insights offer a way of thinking about political relations it is quite another to suggest that they can be used to promote or justify a political agenda. While Altman and Peltz theorize about the negative impact of manic defense in contemporary culture, this commentary suggests that there are natural fluctuations in one's ability to respect inner reality and a degree of manic defense employed in everyday life that is quite normal. We all use reality to gain reassurance against death inside. But, when we are >distracted from distraction by distraction< (Eliot, 1971, p. 120) external objects are prematurely deadened so that the needed reassurance through external reality becomes increasingly elusive. Challenging some of Altman and Peltz's political assumptions, the commentary suggests that if psychoanalysis is to contribute to the political realm, it must do so on the basis of how it differs from other approaches to understanding what it means to be a human being.