Fantasy and psychoanalytic discourse.
Explore the source record for details and available documents.
Fantasy↗
Biomedical subjects
S T Levy
Publications and source records attributed to S T Levy.
Regression and psychoanalytic technique: the concretization of a concept.
An exploration of the regression concept historically and conceptually reveals that its familiarity and frequent use have resulted in decreasing conceptual clarity and precision. Rooted in an outmoded fixation-regression model of development and psychopathology, the concept has become concretized. This paper is a beginning exploration of problematic aspects of the concept of regression, with emphasis on potentially detrimental consequences for psychoanalytic technique that derive from its unexamined use. Some of the salient issues are illustrated with clinical examples.
Adult↗
Suggestion and psychoanalytic technique.
The role of the analyst's suggestive influence on the course and outcome of psychoanalytic treatment is explored, and traditional and newer perspectives on analytic technique are contrasted. The intersubjective critique of the neutral, objective analyst in relation to suggestion is examined. The inevitable presence and need for suggestive factors in analysis, and the relationship of suggestion to transference susceptibility, are emphasized. The manner in which the analysis of suggestive factors is subsumed in transference analysis as part of traditional technique is highlighted.
Humans↗
The psychoanalyst in the academic community.
Explore the source record for details and available documents.
Education, Medical↗
Repetition compulsion revisited: implications for technique.
Freud's repetition compulsion concept is reviewed and examined critically. It has been used as an explanatory concept to cover a wide variety of clinical phenomena similar only in their manifest repetitive quality, and it appears frequently in psychoanalytic and psychiatric literature. Its relationship to trauma and posttraumatic stress disorder is explored. Emphasis is on the detrimental technical legacy of the concept, which has cast a pessimistic aura of unanalyzability over a wide variety of repetitive phenomena, especially analyzable resistances related to aggressive conflicts. We conclude that the repetition compulsion is an anachronistic concept with detrimental technical implications and that it should be retired.
Aggression↗
Comorbid postpartum depression and bereavement: a complicated case.
Explore the source record for details and available documents.
Adult↗
Safety, danger, and the analyst's authority.
The concepts of safety and danger as they pertain to the psychoanalytic situation are examined, with a special interest in casting aside familiar unquestioned presumptions about the therapeutic effects of the analyst and the setting as safe and therefore facilitating of self-disclosure, insight, and change. The merit of viewing the situation as in itself neither safe nor dangerous is argued, and problems are noted in the uncritical acceptance of the illusion of safety and attempts to use it for therapeutic purposes. Such an illusion denies the psychological and biological vulnerability of all human beings, especially in relation to aggression. In the clinical setting, working from an unexamined presumption of safety interferes with full transference expression and the analysis of aggression, often in the service of sparing the analyst from fully experiencing the analysand's adult aggressive potential. Contemporary interest in the analyst's authority, particularly efforts to undo it, can profitably be viewed as helping to maintain an illusion of safety during treatment in order to avoid the real dangers that are experienced as present and that are therefore available for exploration and mastery.
Adult↗
On those wrecked by success: a clinical inquiry.
Freud's description of those wrecked by success outlines conflicted oedipal triumph as the central underlying dynamic in this character type. It does not distinguish those patients who avoid success from those driven to achieve and then wreck their success. We present a complex picture that we believe is prototypic of patients who destroy their success. A clinical case illustrates our point of view. We emphasize the developmental problems we believe typical of patients who dramatically wreck the success they achieve. We hope to extend rather than replace Freud's landmark contribution to our understanding of this type of character pathology.
Humans↗
On grist for the mill: external reality as defense.
The meaning of the "grist for the mill" metaphor has undergone a shift from "analyzing everything" to "everything is analyzable." This is used as a point of departure for exploring some of the multiple, complicated, and often unrecognized ways reality is used defensively by analyst and analysand. The point of view presented is in the spirit of a balancing perspective with regard to current trends in psychoanalysis which emphasize interactions, the analyst's contribution to transference, reality experiences as causation of psychopathology, and the role of the "real" relationship in the mechanism of therapeutic action.
Defense Mechanisms↗
Neutrality, interpretation, and therapeutic intent.
Neutrality is a central concept within the theory of psychoanalytic technique. We spell out the major controversies in which the concept has become embroiled, and provide a definition that we believe coincides with actual psychoanalytic practice. We discuss its merits and weaknesses, noting also the negative consequences of relying on older definitions. We relate neutrality to the interpretive process, indicating ways interpretation protects neutrality and is made more effective by it. We discuss the complex and controversial relation between neutrality and the analyst's therapeutic intent.
Austria↗
Unconscious fantasy: a reconsideration of the concept.
Despite general agreement about the clinical importance of unconscious fantasy, the concept itself has remained unclear. After reviewing Freud's work on the subject, the conceptual dilemma is specified: where in current psychoanalytic theory do we place this important, dynamically repressed, structuralized mental content? Three conceptual paths have been followed in attempting to deal with this problem. The first emphasizes the structural, tripartite model, discarding topographic concepts. The second replaces the structural model with a schema model borrowed from academic psychology. The third combines the structural and topographic models. None of these approaches is entirely satisfactory and without problems. Because of their central role in mental life, unconscious fantasies deserve careful definition. They should be distinguished from conscious fantasies and daydreams as well as from the process of fantasizing. They are differentiated from other varieties of unconscious content by their enduring quality and their organized, storylike quality reflecting the distortions typical of the primary process. As dynamically unconscious templates from the childhood past, they shape subsequent compromise formations and are relatively impervious to new experience. The development of psychoanalytic theory from a macrostructural to a microstructural emphasis is discussed in relation to the unconscious fantasy concept.
Fantasy↗
The analytic surface and the theory of technique.
This paper examines the concept of the analytic surface as a starting point for the interpretive process in relation to the theory of psychoanalytic technique. The history of the concept of the analytic surface within psychoanalysis is reviewed. Four different conceptualizations of analytic surfaces are described (M.M. Gill, P. Gray, A. Kris, E.A. Schwaber). The advantages of a "surface" approach are explored in relation to clinical work, the teaching of psychoanalytic technique, and opportunities for research. Some criticisms of the concept are explored.
Humans↗
Negativism and countertransference.
The purpose of this work is to explore the phenomenon of negativism and the analyst's response to it during the course of analytic work with a patient in whom negativism is a central behavioral pattern. Melville's short story, "Bartleby the Scrivener," describing in telling detail the response of a sympathetic lawyer to profound and pervasive negativism in his legal scribe, is discussed as a literary analogy to the analyst-analysand dyad. Aspects of the concept of negativism within psychoanalysis are discussed. The potential usefulness of understanding certain unexpected countertransference responses to pervasive negativism is explored, as this is a relatively neglected area of psychoanalytic technique. A case is presented describing the analysis of a patient whose character, like Bartleby's, is a mixture of profound negativism along with schizoid, obsessional, and masochistic elements.
Countertransference↗
Therapeutic strategy and psychoanalytic technique.
The role of therapeutic strategy within psychoanalytic technique is described. An antistrategic bias inherent in certain aspects of the "classical" technique is explored in relation to the historical development of psychoanalysis. Clinical expertise, which includes the making of strategic or tactical choices, is relegated to the "unofficial," due in part to this negative bias impeding the study of technical differences in favor of general agreement about a theory of technique that may differ considerably from actual clinical work. A case is presented that illustrates strategic choices in the management of a severe character resistance in a supervised analysis. Some consequences of a negative bias against therapeutic strategy as it relates to psychoanalytic training is described.
Adult↗
Empathy and psychoanalytic technique.
I have attempted to review the major psychoanalytic contributions to our understanding of empathy within the psychoanalytic situation. In doing so, I have discussed the relation between empathy and identification, reviewed aspects of the metapsychology of analytic comprehension, and have described the role of the analyst's evenly hovering attention in empathic responsiveness, as noted by several analytic investigators of empathy. The interrelations between empathy and countertransference have been described, and neutrality issues as they relate to empathy have been noted. Certain themes around the development of empathy have been grouped together and critically examined. The work of Kohut with regard to empathy has been discussed in relation to earlier psychoanalytic contributions of which it is an outgrowth and expansion. The changes in meaning and emphasis of empathic processes in Kohut's works have been described and critically reviewed. Empathy in its popular usage refers to the capacity of one person to communicatively partake, in a limited way, in the experience of another. In its differentiation from sympathy and pity, its noncritical or value-neutral character is emphasized. This description of empathy indicates its relevance to psychoanalytic technique, which shares many similar characteristics. Empathy is a general or superordinate term for many more specific aspects of the sensitive interpersonal interactions in the intimacy of relationships like the psychoanalytic one. Attempts to assign a particular psychoanalytic technical meaning to empathy or build clinical and developmental theory around empathy are limited by the multiple referents and generality of the concept. Empathy as a term has its place as descriptive of the analyst's emotional relatedness to the patient. It does not refer to any specific psychoanalytic technical intervention or theoretical construct; rather, it describes in a general way the sensitive, tactful, and experience-near way in which the analyst approaches the inner life of his patients.
Affect↗
Psychoanalytic perspectives on emptiness.
A clinical example illustrates the thesis that the experience of feeling empty, like any other mental event, can be understood in terms of the conflicting wishes, prohibitions , compromises, and gratifications that color any experience in ways that clarify its meaning. Theoretical hypotheses which explain mental events and experiences as the result of deficiencies of structures are difficult to translate into therapeutic practices. This is especially true in the case of the experience of emptiness which, in and of itself and often vigorously, asserts an absence of content. The equating of deficiencies of structures, however formulated, with deficiencies in mental content or activity can result in unconsciously joining the empty patient in repudiating important aspects of internal life, maintaining ultimately pathological gratifications , and often contributing to treatment stalemates in which the "absence of content" is often preferred to the presence of frightening wishes, fantasies, and memories.
Adult↗
Sealing-over in a therapeutic community.
Integrating and sealing-over are terms that are frequently used to describe a patient's general style of coping with stress, especially the stress of an acute psychotic break. Work to date (McGlashan et al., 1975, 1976, in press; Levy et al., 1975) has defined these terms both clinically and dynamically within the context of a patient's relationship to his own psychosis. Integration and sealing-over as concepts have also proved useful in understanding and describing interpersonal and group behavior on an inpatient psychiatric unit. A patient's ultimate style of recovery from an acute psychotic episode results from many forces-internal and environmental. The tendency to either review and assimilate (integrate) or deny and repudiate (seal-over) the often painful affects and ideas prominent during psychosis mobilizes various forces within the patient's social environment. The way in which the therapeutic milieu and patient interact with one another reflects and, in part, determines the manner and degree to which each party comes to master the patient's psychotic experience. This report explores this interaction as observed in an inpatient therapeutic community established to treat acutely schizophrenic patients.
Adolescent↗
Art and recovery style from psychosis.
The concepts of integration and sealing-over as recover styles from acute psychosis are common clinical parlance. Our experience with acute schizophrenic patients has led to specific operational definitions and a scale which can reliably assign patients to these two categories. All acutely schizophrenic patients on an NIH Clinical Center research ward participated in individual art sessions during drug-free periods at admission, at discharge, and at 1-year follow-up. In each session, the patient drew: a) a picture of his choice; b) a self-portrat; and c) a picture of his psychiatric illness. We hypothesized that integrators would pictorially represent themselves and their illness with greater expression, ideational fullness, and affective force than patients who sealed-over. Twenty-four patients were divided equally into integrator and sealing-over groups (based upon ratings at follow-up) and matched for age, sex, and race. Their art productions were presented randomly to two independent raters unfamiliar with the patients. They scored pictures quantitatively for color, motion, detail, empty space, and global expressiveness. Inter-rater reliability was satisfactory. A mean rating was obtained for all pictures from each patient on each of the five art variables. Paired t-tests (two-tailed) were applied to contrast the two groups on each of the five art variables. The results were that the integrators used more color (p less than .05), drew with greater detail (p less than .01), and more globally more expressive (p less than .05). Integrators also tended to depict more motion (p less than .10), but were not different from the sealing-over patients in amount of space left empty. These results support the validity of integration and sealing-over as defined and support the use of art as a medium through which differences in individual styles of coping with the psychosis can be discriminated. Slides of the patients' artwork illustrate the findings.
Adult↗