Therapeutic Passion in the Countertransference

The Couple Therapist as Moral Agent

Partners in intimate relationships rely on each other to meet essential emotional needs. This mutual dependence creates reciprocal obligations, engendering a moral dimension to intimate relationships. This moral dimension involves questions of fairness, equity, and justice which are often central to couples' presenting complaints in treatment. This paper proposes that moral considerations in couple therapy are not only inevitable, but potentially beneficial, and illustrates how they can inform the therapist's case conceptualizations and interventions. This paper will also explore the therapist's responsible use of her moral influence through an examination of personal values. This paper utilizes concepts from psychodynamic and family systems theory to illustrate key points, but the ideas presented apply to therapists with diverse theoretical orientations.

Reconsidering Regression in Psychoanalysis: Notes on a Central Yet Controversial Concept and Its Relation to Free Association

The concept of regression is schematically reviewed, focusing on the complexities and confusions that have surrounded this contested notion in the course of psychoanalytic history. Clinical illustrations are used to suggest descriptive differences in regressive functioning occurring in the course of psychoanalysis. It is argued that there may be an important distinction between the sense-making (adaptational, maturational, and integrative) aims of therapeutic discourse and the distinctively deconstructive conditions of a psychoanalytic process. In this context, the "regressive" impact of the free-associative method is illustrated, and on this basis, it is suggested that there is a significant and profound difference between "free association" conceived simply as uncensored storytelling and "full-on free association" as closer to the babbling of a stream of consciousness.

Who Do the Words Come From: A Psychoanalytical Tale

My first experience in analysis with a classically trained analyst left an unexpected but profound imprint on me. After enduring that kind of one-person analysis for eleven years, I was not left with a favorable impression of the method. Originally trained as a classical psychoanalyst, I have since chosen to work intersubjectively and interactively, and I am shifting more deliberately and with more conviction toward an assimilative integrative psychotherapy approach. In this paper I tell the story of my personal analysis and outline the conclusions I have drawn from it that created a seismic shift in my way of thinking and working as a psychoanalyst.

COUNTERTRANSFERENCE DREAMING: LIFE IN THE INTERSUBJECTIVE THIRD

In this paper the author asks, "How long is the life of an intersubjective field?" She proposes that it is possible for the field to remain active and instructive even after formal sessions have ended: This occurs in her case of Carla, a young woman who terminates prematurely. Carla enters treatment in a downward spiral of severe trauma symptoms that began subsequent to her rape, a decade earlier. Although Carla's symptoms diminish and the analysis continues to be productive, it suddenly ends in an impasse, leaving the analyst perplexed and feeling professionally insufficient. Months later, she has three dreams pertaining to Carla and her rape. Largely employing Jessica Benjamin's recognition theory and her representation of the intersubjective third, as well as contemporary Bionian thinking, the paper depicts how countertransference dreaming is one example of how the intersubjective field can carry on the psychoanalytic function-even outside of formal treatment.

Ethical Presence in the Psychoanalytic Encounter and the Role of Apology. Am J Psychoanal 2018;78:28-46. [PMID: 29422685 DOI: 10.1057/s11231-017-9128-z]

This paper discusses aspects of ethical presence in psychoanalysis, and the possible use of apology in the therapeutic process. The author roughly delineates two periods in the history of psychoanalysis regarding the ethical dimension-the early classical period which is influenced by Freud's ethics of honesty, which gradually evolves towards the more recent intersubjectively-influenced period, necessitating the assimilation of an ethics of relationships. It is suggested that explicit theorizing of the ethical dimension into psychoanalysis offers added value to its effectiveness, and a framework is presented for combining relational, intersubjectively informed ethical dialogue, with contributions of classical technique, enriching the therapeutic potential of psychoanalytic work.

Truth Axes and the Transformation of Self

Freud adhered to the idea that psychoanalysis is a science and that truth is one. The transition from a realistic epistemology to an epistemology of subjective idealism in psychoanalytic thought was accompanied by the splintering of the "one" realistic truth into a multiplicity of truths: realistic-correspondent, ideal, subjective-existential, intersubjective, coherent, and pragmatic truths. The present paper, employing the concept of "truth axes," explores these truths as they relate to basic human needs, self- states, and the structuring of subjectivity. Truth axes are posited as organizing principles of the psyche aimed at achieving stable images of reality across critical dimensions of the subject's life. Personality and experience render some axes dominant, while others remain foreclosed and dissociated. In this construal, the psychoanalytic process concerns the detailing, depicting, and understanding of the various truth axes. The psychological definition of truth illuminates its relation to clinical objectives and methodologies and emphasizes the ethical dimension involved in prioritization of truths. These ideas are illustrated by clinical vignettes.

Enactments in Psychoanalysis: Therapeutic Benefits

The therapeutic benefits of enactments are addressed. Relevant literature reveals disparate conceptions about the nature and use of enactments. Clarification of the term is discussed. This analyst's theoretical and technical evolution is addressed; it is inextricably related to using enactments. How can it not be? A taxonomy of enactments is presented. The article considers that enactments may be fundamental in the evolution from orthodox to contemporary analytic technique. Assumptions underlying enactments are explored, as are guidelines for using enactments. Finally, the article posits that enactments have widened the scope of analysis and contributed to its vitality.

The analytic state of consciousness as a form of play and a foundational transference

The analytic state of consciousness is a particular regressive altered state in the patient characterized by an increased sensitivity and reactivity to impressions arising from both the inner world and the analyst, a heightened sense of dependence and vulnerability, a permeability of boundaries in regard to the analyst, and a shift toward functioning on the basis of omnipotent fantasy in the analytic relationship. These changes are accompanied by a feeling of realness of one's psychic reality, but without any true loss of reality testing. Based on an analysis of the structure of play, this state can itself be understood as a kind of play; it serves as a foundational transference underlying more specific transference manifestations; and it is central to the analytic process. Over time, in response to physical aspects of the analytic setting, its safety, the analyst's emotional accompaniment, and a generally restrained analytic stance (an issue I discuss in some detail), it emerges in a more developed form that promotes symbolization and ownership of aspects of self, greater emotional presence, and a deeper sense of meaning in one's experience. Additionally, the concept of the analytic state of consciousness provides a new look at the role of abstinence and frustration in analytic process.