The patient's experience of therapeutic benefit.
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Goals↗
Biomedical subjects
O Renik
Publications and source records attributed to O Renik.
Subjectivity and unconsciousness.
Concepts of the unconscious were crucial to both Jung's and Freud's thinking. Psychoanalytic and analytical psychological views of the unconscious are compared and contrasted, and both are critically reviewed. It is suggested that we need to revise our conceptualization so as to take better account of the role of the analyst's expectations and inferences, and therefore of his or her subjectivity, whenever he or she makes a clinical judgement that unconscious mental processes are in operation. Some technical implications of a revised definition of unconsciousness are considered, especially indications for self-disclosure by an analyst of his or her own experience of events within the treatment.
Adult↗
Playing one's cards face up in analysis: an approach to the problem of self-disclosure.
A policy of consistent willingness on the analyst's part to make his or her own views explicitly available to the patient is discussed and illustrated by clinical vignettes. Playing one's cards face up is contrasted with contemporary conceptions of selective self-disclosure by the analyst, especially with respect to the way ground rules for the analytic treatment relationship get established. The objective of the analyst playing his or her cards face up is to create a candid dialogue, thus facilitating maximally effective collaboration between analyst and patient. Concerns about the analyst's self-disclosure foreclosing exploration of the patient's unconscious fantasies and transferences, or intruding upon the patient's autonomy, are addressed, as is the relation between self-disclosure and an individual analyst's personal style.
Female↗
The analyst's subjectivity and the analyst's objectivity.
The author suggests that, increasingly, contemporary psychoanalysts have been acknowledging and examining the intersubjectivity of the clinical encounter and that this trend has sometimes been misunderstood as necessitating the conclusion that objectivity is impossible to achieve in clinical psychoanalysis. In contrast to this, the author proposes a pragmatic definition of the analyst's objectivity that is entirely consistent with acceptance of the analyst's irreducible subjectivity, and illustrates his view by means of a clinical example. He suggests that objectivity concerns both objects and objectives, and indicates that a pragmatic conception of objectivity is employed throughout modern science. He explains why he regards psychoanalysis as a science, rather than as a hermeneutic discipline. He takes up the way in which implicit positivist assumptions can disadvantageously influence our thinking about the relation between an analyst's subjectivity and an analyst's objectivity. Finally, he discusses the important role of consensus in objectivity generally and in psychoanalytic objectivity particularly, as well as some of the differences that exist among analysts with regard to the specific objectives that take priority in clinical work.
Adult↗
Getting real in analysis.
A detailed clinical example is used to illustrate how reality testing can create rather than foreclose opportunities for analytic investigation. It is proposed that effective analysis of transference within the treatment relationship requires close and explicit attention to considerations of reality. The author reconsiders certain conceptions of a special psychoanalytic reality, of regression in clinical analysis, and of the nature of free association, suggesting that they tend to discourage the realism necessary to productive psychoanalytic work. He underlines the importance of ongoing reference to therapeutic outcome as an aspect of reality.
Adult↗
The perils of neutrality.
The concept of analytic neutrality is reviewed with respect to its utility as a technical guideline. Participation of an analyst's personal judgments and affects in clinical work is discussed in relation to differing conceptions of how learning takes place in analysis. The question of what actually protects a patient from being exploited by an analyst is considered. A case example is provided as a basis for discussion.
Adult↗
The role of analyst's expectations in clinical technique: reflections on the concept of resistance.
The role played by an analyst's expectations in technique is taken up via consideration of the advantages and disadvantages of the concept of resistance. A conception of resistance is presented, and specific clinical interventions suggested by it are illustrated and discussed. The principle of even hovering attention as an ideal analytic attitude is criticized.
Defense Mechanisms↗
The ideal of the anonymous analyst and the problem of self-disclosure.
The principle of analytic anonymity is critically reviewed. A connection between the technical stance of nondisclosure and idealization of the analyst is proposed. Some preliminary suggestions are offered concerning what kinds of information about the analyst are useful to communicate to a patient.
Defense Mechanisms↗
Publication of clinical facts.
This article explores a correspondence between the conduct of clinical psychoanalysis and the publication of clinical facts in the psychoanalytic literature. At issue in both activities are the nature of psychoanalytic understanding and the way psychoanalytic understanding is communicated. An analyst intervening in the treatment situation offers an interpretation to a patient; an analyst publishing a clinical case report offers an interpretation to colleagues. How can we best judge the validity of an interpretation in either instance? How do we conceptualise the accuracy of a published clinical fact in the light of the observing analyst's irreducible subjectivity? Is disguise for the purpose of preserving confidentiality acceptable in the publication of clinical facts? These and related questions are taken up, using an illustrative clinical vignette as a basis for discussion. The publication of clinical facts drawn from systematic empirical research studies is compared with the publication of clinical facts drawn from observations made by single treating analysts.
Communication↗
Analytic interaction: conceptualizing technique in light of the analyst's irreducible subjectivity.
Every aspect of an analyst's clinical activity is determined in part by his or her personal psychology. The implications for our theory of technique of taking the analyst's subjectivity fully into account--which we have tended not to do--are discussed.
Awareness↗
A case of premenstrual distress: bisexual determinants of a woman's fantasy of damage to her genital.
Case material is used to illustrate specific clinical application of the concept of primary femininity. Some contemporary contributions to the psychoanalytic theory of female psychosexual development are presented as complementary with, rather than contradictory to, more familiar, longstanding formulations that emphasize phallic strivings in women. In the clinical example reported, a fantasy of genital damage underlay a woman's premenstrual distress. Aspirations and concerns related to both aspects of her fundamental bisexuality participated in symptom formation and had to be investigated in order to achieve symptom relief. As the analytic work unfolded, it could be seen that the patient's awareness of her feminine aims served to keep her masculine aims out of awareness, and vice versa.
Adult↗
Use of the analyst as a fetish.
In some cases a gratifying transference fantasy is the subject of progressive analytic work, while in other cases the same type of fantasy eludes investigation, and its enactment causes treatment to become an unproductive endless task. One cause for the latter difficulty can be that the patient uses his or her analyst as a fetish, permitting the distinction between reality and fantasy to remain inconclusive, so that relinquishment of magical expectations does not take place. The particular form of thinking involved in use of the analyst as a fetish is described. The role of illusion, its various clinical manifestations, the countertransference reactions they can evoke, and the technical problems posed are discussed. Special attention is given to the crucial issue of termination. By considering extreme instances in which use of the analyst as a fetish predominates, the author hopes to call attention to a phenomenon that appears to some degree in many, if not all, analyses.
Countertransference↗
One kind of negative therapeutic reaction.
A case is reported in which a young man for several years experienced his analysis primarily as a source of pain. Each new insight he achieved was an occasion for increased distress rather than liberation. Considerable analytic work elucidating motives for this negative therapeutic reaction produced no change in it. Eventually, it could be determined that the patient's need to suffer within the treatment relationship served a specific form of denial in fantasy that has not, to the author's knowledge, been described elsewhere. The importance of covert libidinal, object-preservative aims in such frustrating and destructive impasses is discussed, as well as the role of countertransference enactment.
Aggression↗
The Biblical Book of Job: advice to clinicians.
Study of the Book of Job clarifies the particular adaptation to trauma that underlies the suffering of certain difficult patients. In addition, the misdirected efforts of Job's comforters in the Bible story help us understand why, with such patients, an analyst's attempts to address unconscious guilt and defenses against it will prove counterproductive. A case example is presented.
Bible↗
Analysis of a woman's homosexual strivings by a male analyst.
Clinical material is presented describing how analysis of the homosexual aspects of a woman patient's transference to a male analyst unfolded. Comparison and contrast is made to previous case reports and discussions of the impact of the analyst's actual gender on analytic work.
Adult↗
Comments on the clinical analysis of anxiety and depressive affect.
In listening to clinical material, the analyst frequently has to decide among several apparently valid avenues of investigation. The author examines an aspect of the way he chooses among technical alternatives. His perceptions of an analysand's motivations are influenced by two complementary affect-defense configurations: inhibition in response to anxiety and enactment of wishful fantasy in response to depressive affect. These conceptualizations act as deep structures at the base of his clinical thinking and give direction to his analytic activity. A connection is suggested between the choice to analyze one or another specific affect-defense configuration and the sequential unfolding of tolerable frustrations and gratifications for the analysand.
Adult↗
The concept of a transference neurosis and psychoanalytic methodology.
Implicit in Freud's definition of transference neurosis is the valuable concept that evolution in the observable form of a patient's transference can be used as a criterion of analytic progress. Problems have arisen because the concept has been misapplied. Freud and those who followed him focused attention on clinical developments that are not in fact indicators that successful analytic work has taken place. It is suggested that transference neurosis be identified in terms of a different set of clinical observations than is usually used. Emphasis is given to evolution in the form of the analyst's activity, as well as the patient's, when analytic progress occurs. Validly applied, the concept of transference neurosis can provide a dependent variable whose appearance or non-appearance enables the testing of hypotheses about the psychoanalysis of neurotic patients.
Freudian Theory↗