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PubMed2003

Idealization and psychoanalytic learning.

Idealization is an intrinsic part of psychological maturation, but it is also a potential barrier to psychoanalytic learning, and must to some degree be outgrown if an analyst is to develop a natural authority and individual style. Unrecognized idealizations stifle analysts' engagement in the transferences of their patients, and so compromise the ability to freely experience and analyze them. Attention to real life and the lessons it teaches counterbalances the tendency to idealize and encourages lifelong psychoanalytic growth.

Awareness↗
PubMed2003

Psychoanalytic supervision of the difficult patient.

Control cases from the broad group of non-neurotic but potentially analyzable patients appear with increasing frequency. The intense, complex transferences they develop place great stress on the psychoanalytic relationship and evoke marked countertransference reactions in psychoanalytic candidates, which reverberate within the supervisory relationship. Through application of a case study method, common themes emerge in the candidate-supervisor dyad: idealization of the supervisor and of classical technique, identification with the patient, parallel process enactments, difficulty maintaining the analytic frame, and the importance of concurrent training analysis. Classical supervisory techniques must be adapted to the "difficult" (non-neurotic) control case. Complex countertransference issues must be carefully addressed while maintaining the teach/treat boundary.

Adult↗
PubMed2003

On supervising the pregnant psychoanalytic candidate.

The role of the psychoanalytic supervisor is complicated when the psychoanalytic candidate is pregnant. Pregnancy is a special event that brings a unique set of opportunities, as well as problems, into the analysis, though in the past, it was usually regarded only as an impediment. The goal of this paper is to help the supervisor of the pregnant candidate to seize the opportunities and mitigate the problems. The authors make practical suggestions about the handling of maternity leave and the complex theoretical and technical issues surrounding the question of when and how to tell the patient about the analyst's pregnancy.

Adult↗
PubMed2004

The analyst's fantasy of the ideal patient.

Using detailed clinical vignettes, the author illustrates how the analyst's fantasy of the ideal patient can be used to advance an analysis at the same time as it fuels mutual resistances. The author suggests that all analysts carry with them a fantasy of the ideal patient that varies from analyst to analyst and from school to school. Such fantasies are often related to images of an ideal free-associative process. They are for the most part descriptively unconscious, becoming conscious only when prompted by the clinical moment. As such, they are part of a countertransference, broadly defined, that is responsive to both the analyst's and the patient's conflictual life.

Adult↗
PubMed2004

The psychoanalyst as individual: self-analysis and gradients of functioning.

The authors discuss the position of the analyst as an individual and the idea that his mental functioning can be seen as a meaningful element of the analytic field. The first part of the article shows the importance of the analyst's self-analysis, with particular attention to periods when the analyst is facing a difficult time, self-analysis in supervision, and the exploration of transgenerational influences. The authors go on to discuss the many gradients of the analyst's mental functioning, and these are mirrored in the patient's text, an indication of attunement.

Adult↗
PubMed2004

One form of self-analysis.

Beginning with Freud, psychoanalysts have discovered media through which they may achieve a self-analytic experience (for example, by use of dreams, fantasies, reveries, memories, and even visual images). Each of these media is a kind of "fiction" created by the analyst that provides an imaginative space where he or she may gain access to unconscious life. The author demonstrates how a generative self-analytic experience may be accomplished through the medium of psychoanalytic writing: a fictional autobiographical form of writing through which a self-analytic experience is created that has much in common with the analytic experience created by the analyst and analysand.

Autobiographies as Topic↗
PubMed2004

Haunted by parents--a literary example of change meaning loss: Edna St. Vincent Millay.

The author uses the life and personal history of the poet Edna St. Vincent Millay, as revealed through her diaries and letters and in biographies, to illustrate a particular type of psychoanalytic patient. Such patients are resistant to change, particularly when it involves letting go of the internalization of early parental figures. Although some of these patients fail to achieve successful analytic outcomes, Millay is an example of someone with similar circumstances who nevertheless made significant creative contributions.

Adult↗
PubMed2004

Father hunger and narcissistic deformation.

The author advances the hypothesis that paternal availability and the relationship between the mother and father are crucial components of evolving character structure in children. He proposes that a kind of narcissistic pathology featuring perverse sexuality may eventuate in the absence of paternal availability and in the presence of a disordered relationship between the parents. He also suggests that the ways in which aggression is or is not modulated and organized are crucial components of this evolving disorder, and that boys are more susceptible to its full manifestation and expression than are girls.

Adolescent↗
PubMed2004

Transcending bitterness and early paternal loss through mourning and forgiveness.

This paper provides an in-depth account of a clinical path to forgiveness following a complicated, delayed mourning of an early loss by a man now entering old age. The search for mourning and forgiveness in light of extreme bitterness in advancing age is highlighted. Despite the intimate connection between mourning and forgiveness, this paper attempts to highlight important differences in their dynamics and psychological aims. Forgiveness is conceived as work, unconsciously motivated, to safeguard and complement the psychological gains of mourning. The distinct features of forgiveness facilitating psychic reorganization, as well as the adaptive function of refusal to forgive as a defense against melancholia, are discussed. The paper concludes that in this case, the motivation for forgiveness was to repair a powerful narcissistic injury.

Adaptation, Psychological↗
PubMed2004

To have and to hold: on the experience of having an other.

This paper reconsiders familiar concepts (such as internalization, object representation, and object constancy) in light of the notion of having, in order to facilitate creative thinking about how patients are or are not capable of experiencing analysts-and how analysts allow them to do so. The meaning of Other-having is examined from both a theoretical and a subjective point of view. The author suggests that the sense of having an Other results from positive real experiences, and that the ability to have an Other is the sine qua non, the building block, of all mental functions that require empathy.

Adult↗
PubMed2004

Hearing the faith in time: countertransference and religious metaphor in an oncology patient's psychotherapy.

Material from the psychoanalytic psychotherapy of a patient with breast cancer demonstrates the emergence of constructive meaning in areas of psychological experience burdened by conflicts regarding the dimension of time and faith. During analytic work, the spontaneous appearance of religious metaphors revealed deeper layers of memory where time, faith, language, and the sense of being listened to once interacted in ways whose significance could be conceptualized, with the help of the countertransference, as a rediscovery of a hearing breast, or even a sacred hearing breast. Implications for the psychoanalysis of religious experience are discussed.

Breast Neoplasms↗
PubMed2004

When words fail: psychosomatic illness and the talking cure.

This paper discusses psychosomatic illness as a disorder of the individual's subjectivity in relation, or a surrender of mind and mindfulness to the other. Illustrative clinical material highlights the usefulness of Harry Stack Sullivan's (I954) detailed inquiry in locating the psychosomatic patient's own voice in the consulting room. Particular attention is paid to the form and use of language to impede or foster private experience and personal agency.

Awareness↗
PubMed2004

A falsifying adolescent.

The author describes an adolescent patient who, while often speaking factual truths, maintained an aura of falsity in her life, and in two interludes of psychoanalytic psychotherapy, that functioned as a barrier to psychological insight. To match her falsity, the analyst at times modified his functioning as a "real" therapist and took on her personification of neglectful and false adults. Eventually, the analyst became an object that the adolescent could trust and rely on. In discussing the case, the author introduces and applies Bion's ideas regarding truth and falsity, and three variations of container-contained relationships-symbiotic, commensal, and parasitic-in the context of the case's relational perspective.

Adolescent↗
PubMed2005

Conflict in the middle voice.

The author presents material from Homeric texts that is expressed in the middle voice, an ancient Greek verb form that strikes a balance between passive and active voices. A clinical vignette is presented in which the analysand expresses herself in a way that captures some of the sensibility of the middle voice. The author discusses ways in which the vision of human experience expressed by the middle voice, a vision that was developed and elaborated in the later Greek tragedies, can illuminate psychoanalytic approaches to problems of personal agency and conflict.

Adult↗
PubMed2005

Conflict, structure, and absence: André Green on borderline and narcissistic pathology.

The authors understand the work of André Green as addressing unresolved and uncharted issues in Freud's views on the earliest phases of development, particularly as those issues concern the evolution of psychic structure, the development of drive components, and the internalization of object representations. The authors describe Green's conceptualization of primitive conflict and its most deleterious result, absence, or the failure to represent the object. These ideas lead to an original way of imagining the analytic setting and to a modification of the classical stance of analyst with patient. Two clinical vignettes are presented.

Adult↗
PubMed2005

The other side of Oedipus.

The Oedipus complex has been understood as a series of conflicts between feelings of love and hate (sexuality and aggression) in the relationship between the child and his/her parents. This article presents a different view, defining oedipal struggles as conflicts between love and care, sexual desires and self- and object-preservative needs. The crucial conflict the child has to deal with is: to love the one and nevertheless to preserve the other (the rival). Further, the author distinguishes between monolithic conflicts, which are conflicts between different objects of one drive's strivings, and binary conflicts, which involve the objects of both basic drives. In three illustrative examples, she shows that monolithic conflicts can indicate a regressive movement, while binary conflicts tend to foster a progression in the analytic work.

Aggression↗