Analysis of patients in their fifties: some aspects of technique.
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Aging↗
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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↗
[Delusion and dreams in "Death in Venice". Thomas Mann's consequential reading of Freud in 1911].
The author shows by means of literary comparisons that in "Death in Venice" and The Magic Mountain, Mann was strongly influenced by Freud's psychoanalysis, in particular by the latter's work "Delusion and dreams in W. Jensen's 'Gradiva'."
Delusions↗
Analysis without apparent resistance.
With this addition to the slender literature of self-revelations by psychoanalysts, the author also makes what may be his final contribution to psychoanalysis. An episode of hypomania during a visit to his birthplace, Vienna, triggered a dream whose elucidation allowed him to recover a primal scene and complete a self-analysis begun 65 years earlier. Shortly thereafter, a stroke left him hemiplegic and forced the author to confront the final stage of a productive life. After describing a range of adaptations to age and failing health, he explores the role hypomania played in his reconciling with the inevitability of impending death. Analysis of the contending forces also deepens our understanding of the transformations the creative process undergoes in advanced age, a topic the author leaves for younger hands to perfect.
Aged↗
Common ground: an analytic break and its consequences.
This is a clinical report of an analytical process which began under two years ago and in which there was a five-month break at the end of the first year. The break had been discussed in advance, but its effect on the treatment was no less intense on that score. The separation was experienced through feelings of pain with a heavy bodily quality by which she evoked the somatic memories of a heart operation she had when she was a baby. The analytic process seems to be allowing her to symbolize her painful experiences of separation and loss as well as the traumatic effects of her heart surgery.
Adult↗
Psychoanalysis: the common ground.
This paper carries further the theme I developed in my presidential address in Montreal, 'One psychoanalysis or many?' where I discussed the issue of what holds us together as psychoanalysts sharing a common discipline and science despite our increasing theoretical diversity. My response was that our common ground rested in our shared clinical enterprise in our consulting rooms where we relate comparably to the immediacy of the transference-countertransference interplay with our patients. In this paper I reconsider these perspectives in the light of the specific responses to them, including in the six pre-published statements for the Rome Congress which was dedicated to this theme of exploring our common ground; and I then apply these conceptions in my own comparative assessment of the three plenary clinical presentations of the Rome Congress, drawn from the three major world regions of psychoanalytic activity and presented by adherents of three of the major metapsychological perspectives in our field, the ego psychological, the Kleinian, and the object relational.
Adult↗
The psychoanalyst's methodological stance: some comments based on a response to Max Hernandez.
Our theories are to derive from empirical clinical findings. Their task is to order the data and broaden our perceptual scope. But often and unwittingly, we draw upon them to make leaps of inference about unconscious meaning, and bypass untold directions for which the model may not fit. Despite the fact that such super-imposition is generally decried, we are each of us vulnerable to using theory--experience-near or distant--to rationalize hidden assumptions and agendas, to lead our patients to 'truths' we presume we already 'know' to be present. The effort of this discussion has been to highlight this ubiquitous risk and to consider its implications for our psychoanalytic listening and concomitant methodology.
Adult↗
Vertigo and object relationship.
Vertigo appeared to me in analysis to be an expression of separation anxiety; we can observe the vicissitudes of the object relationship by way of the development of this symptom in the treatment. I identify different forms of vertigo according to the particular stage reached by the patient, from fusion-related vertigo via vertigo about being dropped, vertigo associated with aspiration, vertigo connected with the alternation of prison and escape and vertigo related to the attraction of the void, to competition-related vertigo which appears in an oedipal context. They correspond to different moments in the constitution of relational space: first, the two-dimensional world in which even the void is inconceivable; then, the sensation of the void manifesting a disavowal of the absence of relationship; next, the constitution of a three-dimensional space in which the patient initially feels carried by the object but then discovers that he can carry himself; and, finally, the constitution of the internal space which allows internalization of the feeling of 'buoyancy'.
Adult↗
On acting out.
The author sets out to compare her own ideas on the archaic matrix of the Oedipus complex, as opposed to the fully developed Oedipus complex, with Glover's conception of the different developmental stages of the mental apparatus in which historical priority is given to what he calls 'psychosomatic reactions' over later psychoneurotic symptoms. These former result in pure discharge, whereas the latter are characterized by meaningfulness. She also briefly tries to connect some of her views with those of Melanie Klein and Bion.
Acting Out↗
Pathological organizations as obstacles to mourning: the role of unbearable guilt.
A patient is described who made moves to face his internal and external reality only to find that this put him in touch with an internal world in a horrific state. The horror resulted from his view of damaged and imprisoned objects which arose from the way his defences were organized into a pathological organization of the personality which controlled his objects with ruthlessness and cruelty. As he began to loosen his dependence on the organization and to face his internal situation, depressive anxieties became prominent and of these he found guilt particularly unbearable. In order to escape from guilt he retreated once more to the protection of the organization and it is this which prevented him mourning his lost objects. It is argued that it is in the process of mourning that lost parts of the self are regained and it is specifically this process which was interfered with by the pathological organization.
Defense Mechanisms↗
The possibility of human freedom and its transmission (with particular reference to the thought of Bion).
In this paper I examine where Bion's theory of freedom fits within the traditional philosophical debate. I claim that the notion of freedom is the organizing centre of Bion's thought and that the traditional debate has focused with too great a concentration upon the will. I propose that underlying the workings of the will there is a fundamental substratum. This is governed either by the reaction model or by the response model. Freedom is coextensive with the latter mode of functioning but not with the former. The traditional debate needs to take this layer of personality functioning into account.
Gender Identity↗
The gift of laughter: on the development of a sense of humor in clinical analysis.
Clinical analytic change often brings with it a maturing of the patient's sense of humor, leading to an internalized capacity to acknowledge pain and frustration while soothing oneself with wit. Both the nature of psychic functioning, especially the multiple meanings structured in words, and the nature of the dyadic aspects of clinical analysis contribute to this happy outcome. The structural similarities that jokes and humor bear to transference and self-analytic capacities are also considered.
Countertransference↗
The uses of moral ideas in the mastery of trauma and in adaptation, and the concept of superego severity.
The power of moral ideas, here equated with superego strength, has been explained in increasingly complex terms over the course of the development of psychoanalysis. At first regarded mainly as useful in opposing oedipal instinctual demands, morality came to be seen also as opposed to aggressive wishes while at the same time capable of gratifying aggressive and libidinal forces. In this paper, I discuss the contribution to the strength of morality that comes from the effects of painful ("traumatic") experiences and from the use of moral ideas for social, adaptational purposes. In addition I consider the possibility that unchanging moral ideas can have changes in function in clinical work. A case is presented to illustrate these points.
Adaptation, Psychological↗
Can a liar be psychoanalysed?
At first glance a liar is an inauspicious patient for a psychoanalysis, a treatment based on truthfulness. Because it presents in speech, lying may seem a mature difficulty, but analysis reveals that it is primitive, linked to the habitual liar's doubts and anxieties about communication with primary objects which, from several causes, have become for him lying objects. As expected, lying makes for a series of problems which handicap the analytic process. Even so, the paper illustrates clinically the view that if the fundamental level of the lying that emerges in the analysis is addressed by understanding it as the liar's communication that he is a liar in identification with, and acutely anxious about, his lying object--in the transference the analyst--a genuine analytic process can be set in train.
Deception↗
[Do psychodynamic considerations still play a role in degenerative brain processes?].
Drawing on case studies, an attempt is made to show that degenerative grain processes, neurotiv disturbances and puberty can, in combination, lead to grave symptoms for which no one cause alone is responsible. It is therefore also shown how important psychoitherapeutic treatment can be in improving the patient's over-all state, in spite of the progressive nature of brain degeneration.
Adolescent↗
[Sense and counter-sense--on the deconstruction of histories].
Today historiography (the writing of stories) presented as nothing but a search for truth merits the charge of naiveté. Since Freud we must understand any story told about life as a rationalization, that is, as a strategy of conducting one's life. The author argues the proposition that historiography can only fulfill its function of giving sense to life if it simultaneously admits its deconstruction, its counter-sense.
Dreams↗
[Encounters with strangers].
Beginning with three episodes about the encounter with the alien (from a working group, a therapeutic group and from the actual public discussion about aliens) it is pointed out, why the encounter with the alien is both, fascinating and frightening. From the psychoanalytic point of view this is explained with the concept of the representation of the alien, especially under the genetic, adaptive and topic aspects. Finally from the initial examples conclusions for counseling and psychotherapy are drawn.
Adult↗