The act of interpretation

The author understands the interpreting act as an attempt to perceive what happens in the transference/countertransference field and not just what happens in the patient's mind. Interpretation transcends mere intellectual communication. It is also an experience in which analysts' emotions work as an important instrument in understanding their patients. Interpretation is seen to possess manifest as well as latent content; the latter would contain the analysts' feelings, emotions and personality. The unconscious content of an interpretation does not inconvenience or preclude the development of the analytic process, but, on the contrary, it allows new associative material to emerge, and it transforms the analytic session into a human relationship. Analysts' awareness of this content derived from patients' apperceptions is a significant instrument for understanding what is happening in the analytic relationship, and what transpires in these sessions provides fundamental elements for analysts' self-analysis. Some clinical examples demonstrate these occurrences in analytic sessions, and how they can be apprehended and used for a better understanding of the patient. The author also mentions the occurrence of difficulties during the analytic process. These difficulties are often the result of lapses in an analyst's perception related to unconscious elements of the relationship.

From symbolic law to narrative capacity: A paradigm shift in psychoanalysis?

In the Freudian perspective, the primal phantasies, a reflection of prehistory, oblige us through our phylogenetic heritage and its repetition in the ontogenetic to recognize the limits of generation and sex, to submit to the symbolic law represented by the father of the primal horde and to find--as is sought in the treatment--one's "right" place in the primal scene (Oedipus complex). Clinical experience with patients suffering from narcissistic disorders soon led certain analysts to propose a paradigm change, which has brought about important modifications to technique, but also, more recently, modifications at the level of metapsychology. Certain contemporary analysts have a conception of the subject focused on processes of interaction and communication between "thinking apparatuses" in the here and now. The author shows that this current development is taking place in parallel with major trends in our postmodern era in which communication and negotiation replace former religious, mythical, philosophical, moral or political beliefs.

Early trauma and narcissism—autism bipolarity

The analyst makes a series of considerations taken--a posteriori--from the analysis of a small number of patients. These patients have saved themselves from an early narcissistic catastrophe by developing precocious mental processes, while affective relationships rudimentarily repeat the impact with the original trauma. Primitive defences, essentially denial and vertical splitting, dissociate the tear in the psyche and structure a 'narcissism-autism bipolarity', revealed in aspects of the character which oblige the patient to automatically repeat a single matrix of experience. In therapy, it is necessary to construct a 'first time of the trauma', by finding and linking threads of the primary relationship and strengthening them in the analytic relationship. This reconstruction of the background, a screen to project what had originally been rejected, is the prerequisite for coming out, in deferred action, from the hold of the pathological identifications. The author dedicates particular attention to the undifferentiated background, the nature-environment torn by the trauma, and to the need to reconstruct this fabric of experience in the analytical relationship, as a fundamental element to the recomposition of the dissociated nuclei. In the clinical case, the analyst describes in particular how the analyst's words encounter an unbridgeable gap, a failure in the capacity for representation when opening the autistic nucleus. Through a regression lasting for about a year, a patient was able to live the experience of 'primitive agonies' and that of an unbearable helplessness and, at the same time, was able to feel how the analyst supported her sense of existence. Subsequently, the patient was able to give shape, through visual images, to deep states of being and start the process of metabolising and symbolising the trauma.

Affect and the therapeutic action of psychoanalysis

In connection with controversial IJP articles by Stern et al. and Fonagy on the interpretation of the repressed and the recovery of past memories, the author maintains that the affect that is inherent in positive transference is at the heart of therapeutic action. Points of view put forward in the controversy (based on neurobiological knowledge) are related to Freudian metapsychology, as well as to their precursors whose scope was necessarily limited by a lack of access to more recent scientific discoveries. The author demonstrates metapsychological elements of therapeutic action inherent in the intersubjective relationship, especially identification, manifested in introjection and empathy. He describes cognitive development as spontaneously blossoming from the affective nucleus, and he explains the neuroscientific bases of this step forward. The classic (interpretative) psychoanalytic method makes up the cognitive superstructure necessary for the organisation of the mind that has sprung from the affective substructure. As a primary factor in psychic change, interpretation is limited in effectiveness to pathologies arising from the verbal phase, related to explicit memories, with no effect in the pre-verbal phase where implicit memories are to be found. Interpretation--the method used to the exclusion of all others for a century--is only partial; when used in isolation it does not meet the demands of modern broad-spectrum psychoanalysis, as the clinical material presented illustrates.

From bastion to enactment: The ‘non‐dream’ in the theatre of analysis

In this paper, the author's objective is to discuss models that express what occurs in the analytical situation. He demonstrates how early models relating to painting and sculpture, to history and archaeology, develop into other models that refer to the relationship between two people. He studies in depth the Barangers' 'analytical field' with its obstructive bastions as a background to understanding what is currently valued as intersubjectivity in psychoanalysis. The container-contained model and the phenomenon of 'recruitment' are also discussed. The author uses clinical material to demonstrate how these models are linked to 'enactment', and a study of this concept provides evidence of the importance of the visual image, the dream and 'non-dream', the 'affective pictogram', as privileged aspects for the understanding and evolution of thought in the analytical process. Its importance leads to a proposal of a model that uses the theatre as a metaphor for the analytical process. In this model, analyst and patient both participate as characters in the scenes, and simultaneously as their co-authors. The analyst should also be responsible for the direction of scenes, as well as acting as critic. His task is to prevent obstructive conspiracies (the 'non-dream') and find new meanings for the scenes, thus allowing the development of new scenes and plots, and the enlarging of the mental universe.

The many faces of lying

In this paper the author explores the psychic functions of lying and draws on Glasser's (1979) notions of self-preservative and sadistic violence to identify three selfobject configurations. Each of these is associated with specific anxieties to which the lie offers an apparent solution. The first configuration is sadistic lying. Here the intent is to attack and triumph over the duped other. The lie allows the object to be controlled and humiliated. This gratifies the self by reversing an earlier humiliation. The second and third configurations are both forms of self-preservative lying, where the lie may be best conceived as a 'symptom of hope' (Winnicott, 1985). In the second configuration, the object is felt to be unavailable or inscrutable. The lie may be used to create an attractive self that will elicit the object's love, admiration and concern. In this way, the lie serves to eliminate doubt about the object's intentions towards the self. In the third configuration, the object is felt to be intrusive, and the dyadic relationship is overpowering. Here the lie can represent an attempt to insert a third into the relationship.

A psychoanalytic understanding of the desire for knowledge as reflected in Freud'sLeonardo da Vinci and a memory of his childhood

The author offers an understanding of the psychoanalytic notion of the desire for knowledge and the possibility of attaining it as it fi nds expression in Freud's Leonardo da Vinci and a memory of his childhood. This understanding has not been explicitly articulated by Freud but may be considered integral to psychoanalysis' Weltanschauung as shaped by Freud's legacy. It emerges through an attempt to explain basic shifts, contradictions, inconsistencies and tensions that become apparent from a close reading of the text of Leonardo. Articulating this implicit understanding of knowledge provides the grounds for a stance on epistemology that is integral to psychoanalysis and relevant to contemporary psychoanalytic concerns on this topic. This epistemology focuses on the necessary involvement of passion, rather than detachment, in the search for knowledge and views the psychoanalytic aim of self-knowledge as a derivative, and most immediate expression, of a broader and more basic human drive to know.

On Dreaming One’s Patient: Reflections on an Aspect of Countertransference Dreams

This paper explores the phenomenon of the countertransference dream. Until very recently, such dreams have tended to be seen as reflecting either unanalyzed difficulties in the analyst or unexamined conflicts in the analytic relationship. While the analyst's dream of his/her patient may represent such problems, the author argues that such dreams may also indicate the ways in which the analyst comes to know the patient on a deep, unconscious level by processing the patient's communicative projective identifications. Two extended clinical examples of the author's countertransference dreams are offered. The author also discusses the use of countertransference dreams in psychoanalytic supervision.

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.

The Therapeutic Effects of the Free-Associative State of Consciousness

Free association is therapeutically helpful in the regulation of states of consciousness. A person who free-associates enters a particular state of consciousness characterized by increased subjective self-awareness and disregard for reality, together with implicit pulls for objective self-awareness and reality adherence. Free association facilitates the patient's learning to integrate and to shift flexibly among points on these dimensions. Tensions existing in the free-associative state are embedded in a similar tension between free associating and reacting to the analyst's interventions, so interplay between free association and intervention also facilitates regulation of states of consciousness.

Forging Difference out of Similarity: the Multiplicity of Corrective Experience

In the context of work with an adult survivor of childhood sexual abuse, the interplay of multiple forms of engagement contributing to therapeutic action is explored. The compulsion to repeat old patterns is seen to be gradually overcome by new corrective experience in which the whole of the patient's sense of the analyst as a person is greater than the sum of its parts. Interpretation of enactments--often involving patterns of dominance and submission--is complemented by a range of "helpful" actions that must be detoxified. That process entails the progressive differentiation of coercion and influence, on the one hand, and of compliance and responsiveness, on the other In the end, autonomy and creative responsiveness emerge as integral to each other rather than as mutually exclusive. This development requires that the patient gradually relinquish an "essentialist" view of self and other in favor of a "constructivist" view, in which the ambiguity of experience offers opportunities for new forms of relational engagement and understanding.

Whiteness

This paper seeks to make meaning of the experience of being white in the United States at this point in history. The self-awareness of white people is limited by a blind spot around the meaning and impact of being white in a multiracial society. Using psychoanalytic and literary methodology, the author seeks to cast light with which to explore this blind spot. Everyday experiences are used to illustrate the widely pervasive impact of race in the lives of white people, and a clinical vignette illustrates how race might show up in a white-on-white psychotherapy. Enactments within this paper are noted when they are evident to the author

The Filial Piety Complex: Variations on the Oedipus Theme in Chinese Literature and Culture

The Oedipus complex is central to Western tradition, but not to Chinese culture. Occurrence of oedipal themes in Chinese literature is almost negligible. This phenomenon seems to support a contra-Freud claim: that a theory of European origin, the Oedipus complex, is not universal to human experience in non-Western cultures. However, this article suggests that powerful moral repression may cause the Oedipus complex to undergo structural transformations in some cultures. Through studying a sample of Chinese literary and film representations, the author argues that the Oedipus complex in Chinese culture has been transformed into a filial piety complex. Some conceptual issues are considered from a cross-cultural perspective.

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.

Existence in Time: Development or Catastrophe

The experience of existing in time is closely bound up with the phenomenology of the depressive position and, as such, represents a major developmental achievement. However, for some patients, awareness of time and their place in it is felt not as offering the possibility of development, but instead is dreaded as an imminent catastrophe that has to be evaded. This is achieved through the creation of an illusory timeless world, which, although offering some relief compounds the feeling of threat. The author draws on material from Oscar Wilde's novel The Picture of Dorian Gray (1890) and on clinical material from a psychoanalysis to illustrate the attractions and dangers of life in this illusory world, where the "picture in the attic" represents the threat that can never be fully faced nor fully erased. The link between the awareness of time passing and the capacity to mourn is discussed in relation to Freud's paper "On Transience" (1916), which in the author's view anticipates certain features of the depressive position as described by Klein (1935, 1940). The author makes further observations on the relation between instantiation in time, which brings a world of causes and consequences, as well as the capacity for bearing guilt.

Primo Levi’s Loneliness: Psychoanalytic Perspectives on Suicide-Nearness

To elucidate suicide-nearness, the perspectives of the death drive and narcissism are applied to the writings of Primo Levi. Emerging themes are Levi's struggle to maintain his self-regard from his year as a prisoner in Auschwitz and onward, and his observations on xenophobia, violence, and the need for love. The gradual increase of depressive content in Levi's work is noted, as are his identifications with others who succumbed in the Holocaust or took their lives after surviving it. The conflict between the wish for peace and the need for love is seen as impossible to resolve under the threat of extermination and as reemerging in the prevailing sense of loneliness that Levi described.

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.

The Imaginer and The Imagined

A transference of the imaginer and the imagined, arising from largely unconscious fantasies of the way parent and child interact to construct a view of reality, is present in all analyses. For narcissistic patients, primitive fantasies of the imaginer and imagined form an enduring organization, and the enactment of these fantasies in transference and countertransference distorts the way analyst and patient construct meaning. Clinical material demonstrates the deepening that occurs when these fantasies are interpreted.

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.

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.