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

Making More From Less in a Corona-Encircled Analytic Frame and Situation

The author describes how the parasitic coronavirus encircled and disrupted the analytic frame and situation, activating anxiety in both therapist and patient. A patient is described with core intimacy difficulties whose primitive anxieties manifested in him the dis-regulation of the too-far (agoraphobic), too-near (claustrophobic) intimacy dialectic. Drawing on Winnicott, the author describes how these increased dialectic tensions, when contained, created a potentially transformational transitional space that helped to enhance the patient's mental and symbolizing capacity, that is, a capacity to make more from less.

From Battleground to Playground: The Video Game Avatar as Transitional Phenomenon for a Transgender Patient

The language and theories of Winnicott offer a lens for examining the importance of play in the development of the queer, transgender, and/or gender-nonconforming patient and the safety that virtual spaces-specifically, video games-provide for this play. While much of the literature posits the primary therapeutic value of virtual space as the site of psychic battle, interaction with a video game avatar can also be understood as an act of queerness-as-play, a potential cornerstone of healthy identity formation that may otherwise be precluded. An example of this paradigm is given in the case report of a twenty-year-year-old transwoman who used her video game avatar as a tool in her therapeutic progress during her medical transition. For effective psychotherapy to take place, both patient and clinician must have a capacity to play. With this in mind, the clinician might best visualize the virtual space not as a battleground, but as a playground.

The Only Fag Around: Twinship Needs In Gay Childhood

A number of contemporary psychoanalytic writers have characterized gay childhood as a profoundly isolating experience. Within a developmentally informed self psychological framework, the loneliness of gay childhood is theorized here as a deficit in requisite twinship experience in early life. A detailed clinical example illustrates how these thwarted twinship needs may reemerge in the transference to the analyst, and how patients may escalate their acting out when the analyst misattunes to, or altogether misses, manifestations of twinship longings in the transference. A bridge between Freud's theory of the repetition compulsion and Kohut's theory of selfobject transferences suggests how specific moments of thwarted twinship needs may be repeated within the analytic relationship in an attempt to master the earlier experience. The experience of the analyst being pulled into the patient's attempts at mastery is detailed. A broader theoretical trend is hypothesized whereby psychoanalytic theories may have a pull toward twinship between each other.

Empathy as core to the development of holding and recognition: the case of Garret

Heinz Kohut investigated empathy in psychoanalysis in the mid-1950s and found it to be a powerful way to connect to, and be with, his patients. Since then, relatively few recent clinical cases of empathy have emerged, while theoretical discussion of empathy seems to be the norm. Moreover, empathy has not been linked to the development of holding and recognition. The Winnicottian notion of the holding metaphor, which describes the mother holding her infant, has been controversial but continues to be used in therapy. Revised by relational theorists, holding is now viewed as co-created within the intersubjective space. Few recent clinical cases exist showing how and what holding looks like in therapy. The concept of recognition, also used in therapy, is defined as the ability to recognize and experience the other as a separate other. Clinical cases showing recognition in therapy are few in number. As far as I know, no clinical cases suggest that empathy is necessary before holding and recognition can emerge. In this paper, identifying these clinical case gaps in the literature, I describe a small verbatim section of a session with my patient, Garret, in which I attempt to; i) show the empathic process, thus adding to the scarcity of clinical cases, and, ii) show the experience of holding and recognition as they emerge in this case, and iii) suggest that empathy is a necessary core process to the development of the experience of holding and recognition.

The myths of free association and the potentials of the analytic relationship

The author challenges the traditional and still prevalent view of 'free association', arguing that it entails three forms of denial (also formulated in terms of corresponding myths): 1) denial of the patient's free agency; 2) denial of the patient's and the analyst's interpersonal influence; and 3) denial of the patient's share of responsibility for co-constructing the analytic relationship. That responsibility includes some degree of consideration of the analyst's needs. Sometimes, the patient's good judgment to that end may be reflected in what is automatically and mistakenly reduced to a form of 'resistance'. Attention to the patient's responsibility must be balanced against the effort to provide a uniquely safe environment for the patient's revealing of shame and anxiety-ridden feelings and attitudes. But the therapeutic action of psychoanalysis, ideally, includes the cultivation, through lived experience, of the dialectical interplay of self-expression, on the one hand, and caring relational engagement, on the other. Recognition of the patient's free agency does not preclude exploration of constraining structures laid down in the past. On the contrary, it deepens such exploration. At the same time, it opens the door to the possibility of explicit recognition, via challenge, criticism, or affirmation, of the patient's contributions to the analytic work.

Wrestling with Matter: Origins of Intersubjectivity

Recent theories of intersubjectivity attach primacy to the creation of meaning between subjects, obscuring the role of the material world to which both Freud and Winnicott attached significance. Yet, as this article argues, intersubjectivity itself is predicated upon a transitional space between subjective creation and material life. After considering Winnicott's conceptions of psychesoma and transitionality, the author examines the developmental literature for precursors in the encounter with matter that set the stage for the emergence both of symbolic life and of an embodied "transitional subject" to come into being. Clinical illustrations are provided.

The Analyst’s Trust and Therapeutic Action

The analyst's trust, a neglected topic in psychoanalytic discourse, participates in therapeutic action--through the analyst's emotional openness, "unobjectionable positive counter-transference" (see Fox 1998), the holding environment, and the promoting of adaptive internalizations, among other ways. When the analyst's trust--in the patient, in the analyst's self, and/or in the psychoanalytic process--fails, crucial interactions may occur, capable of destroying treatment, or alternatively, of restoring mutual regulatory functions and potentially leading to important mutative processes. Patients benefit from analysts' becoming sensitive to, having useful ways of thinking about, and working with their states of trust and distrust. The author presents clinical examples to illustrate these points.