Why the analyst needs to change: Toward a theory of conflict, negotiation, and mutual influence in the therapeutic process

Paradox and personal growth during crisis

This paper considers situations of personal crisis, which lead to experiences of extreme helplessness and emotional upheaval. It is suggested that although crises may be precipitated by either external or internal events, all crisis situations have a common denominator. What is common to all crises is the disruption and then restitution of the ability to withstand paradox in the experience of the self. Although there is wide variety in the nature of the personal crisis, all crisis situations have similar structural features. Crises are so dramatic and so frequent a phenomenon in the human experience that they warrant serious and thorough investigation of their nature. Because crisis situations are on the one hand so disabling and potentially destructive and on the other hand can open doors to growth and development, they are extremely valuable to deepen our understanding of how crises develop and unfold.

The Relevance of Psychodynamic Psychotherapy to Understanding Therapist–Patient Sexual Abuse and Treatment of Survivors

Regardless of the therapy modality, research continues to point to the therapeutic relationship as a major salient factor in clinical success or failure. When a patient is sexually abused by his or her therapist, this therapeutic relationship is cynically exploited in a way that does not properly serve the essential needs of the patient. When this patient then seeks reparative therapy, the subsequent therapist needs to pay close attention to issues of the relationship which were breached by the previous clinician. In this article, two case studies showing very different dynamics will be presented in order to demonstrate: (1) relevant factors related to transference, countertransference, projective identification, and the analytic third pertaining to the former, abusive therapy; and (2) needs versus wishes, and issues related to boundaries and self-disclosure in the corrective therapy.

Beyond doer and done to: an intersubjective view of thirdness

Analytic work based on the intersubjective view of two participating subjectivities requires discipline rooted in an orientation to the structural conditions of thirdness. The author proposes a theory that includes an early form of thirdness involving union experiences and accommodation, called the one in the third, as well as later moral and symbolic forms of thirdness that introduce differentiation, the third in the one. Clinically, the concept of a co-created or shared intersubjective thirdness helps to elucidate the breakdown into the twoness of complementarity in impasses and enactments and suggests how recognition is restored through surrender.

"Speak to me as to thy thinkings" commentary on 'Interpersonal psychoanalysis' radical façade" by Irwin Hirsch

This article has two purposes. First, a rebuttal to those writers, including Irwin Hirsch, who criticize the current emphasis by relational analysts on the value of affective openness and affective honesty, particularly with regard to their use of clinical vignettes that vividly portray the analyst's use of self-revelation--as if these illustrations were revealing an endorsement of a naive and mindless invasion of the patient's psyche. The second, and perhaps more important purpose, is to illuminate something I feel is obscured by Hirsch's framing the topic of the analyst's "spontaneity" in the context of analytic politics--that an analyst's self-revelation in language is increasingly understood to be not simply "allowable," but a necessary part of the clinical process. Language does not make it less spontaneous nor part of what Hirsch calls a "standardized technique." Its most powerful therapeutic contribution is in facilitating linguistic symbolization of dissociated, enacted, subsymbolic experience that is immune to self-reflective cognition, immune to internal conflict, and thereby unavailable to interpretation until it becomes relationally accessible to language and thought. Both neuroscience and cognitive research support the need for a revised theory of therapeutic action consistent with the growing recognition of the human mind as a nonlinear, self-organizing dynamic system-a system in which normal maturation as well as therapeutic repair depends, developmentally, on an ineffable coming together of two minds in an unpredictable way. From this vantage point, the analyst's self-revelation contributes to the coconstruction of an alive intersubjective space through an ongoing process of engagement between two subjectivities, making the analyst's subjective openness as potentially negotiable as any other aspect of the patient/analyst relationship, rather than an unrepairable "intrusion" into a self-contained psyche.

On gratitude and gratification

Expressions of gratitude from the patient may be regarded by the analyst as a much-needed validation or affirmation of competence. The analyst's need for gratitude may be a relatively silent presence when things are going smoothly or when the analyst's efforts are openly appreciated by the patient. Ungrateful patients, however, are likely to force the analyst to confront his or her unconscious background wish to enact a longed-for mode of relatedness as part of the daily work of psychoanalysis. The analyst's wish for a specific form of object relationship involving a selfless, devoted helper and an appreciative patient who acknowledges having been helped may be thwarted by certain patients at every turn, knowing they are depriving the analyst of a particular form of gratification in their work. For patients of this type, failure may mean success. The implications of this particular form of clinical stalemate are outlined, and a clinical example illustrates some of the challenges encountered in psychoanalytic work with ungrateful patients.

Getting cold feet, defining "safe-enough" borders: dissociation, multiplicity, and integration in the analyst's experience

This paper attempts to explore the fate of the analyst's multiple self/other organizations during times of heightened countertransferential enactment. It is suggested that such countertransference activity involves the "de-homogenization" of otherwise indecipherably integrated self/other constellations, evoked independently or in response to, but always in interaction with, the patient's own unique organization of multiple centers of psychic awareness and unconscious receptivity. An extended clinical example is used to illustrate the theoretical conceptualization.