"Developmental lag" in the evolution of technique for psychoanalysis of neurotic conflict

The significance of the ego in "The Ego and the Id" and its unfulfilled promise

It is not well known that The Ego and the Id, where Freud presented his second model of the mind, and introduced a new role for the Ego, was ignored by many of the major theorists that followed. I will attempt to demonstrate the importance of this new view of the ego for clinical psychoanalysis, and what has been lost by its being ignored.

On looking into The Ego and the Id 100 years after its publication

Freud's publication of The Ego and the Id sparked a diverging set of psychoanalytic models - ego psychology, structural conflict theory, Kleinianism, object relations theories, Lacanianism, etc. - each of which attempted to deal with the clinical limitations of his first topography in regard to unconscious guilt, negative therapeutic reactions and primitive character organizations. This paper attempts to look back on these developments from the perspective of contemporary, post-Freudian psychoanalytic theories.

Psicologia psicoanalitica dell'Io. Una prospettiva europea

Il modo migliore di riscostruire la storia della psicoanalisi non è quello di cominciare dalle teorie ma dagli autori e dai loro contesti. Importanti contributi allo studio dell'Io furono dati in Europa già da Ferenczi e Fenichel, ben prima che Hartmann fondasse la Psicologia dell'Io che egemonizzò il campo negli Stati Uniti. Nell'Europa dell'anteguerra importanti contributi a quella che qui viene chiamata "psicologia psicoanalitica dell'Io" vennero da Anna Freud, Paul Federn e Gustav Bally, e nel dopoguerra da Alexander Mitscherlich, Paul Parin e Johannes Cremerius per la comunità di lingua tedesca e da Joseph Sandler per quella di lingua inglese. Su questa base si potrebbe parlare di "psicologie dell'Io" al plurale, come si fa per le diverse teorie delle relazioni oggettuali. La psicologia psicoanalitica dell'Io di Fenichel attraverso i princìpi tecnici da lui enunciati negli anni 1930 informa tuttora di sé il lavoro di tanti psicoanalisti anche se in modo inconsapevole, soprattutto in Germania. Rappresenta ad esempio l'ingrediente di fondo della "terapia psicoanalitica", empiricamente verificabile, formalizzata da Helmut Thomä e Horst Kächele.

SHIFTING BETWEEN ALTERNATIVE MODES OF COGNITION: CAN FREE ASSOCIATION, IN AND OF ITSELF, PROVE THERAPEUTIC?

From early on in his career, at the time of his treatment of Frau Emmy von N., Freud (Breuer and Freud 1895) recognized the value of listening to the patient's material without attempting to steer it along a particular course. His focus on the method of freie Einfalle (free association), to be presented to the patient as the fundamental rule of analytic treatment, led to his recommendation that the analyst listen with evenly suspended attention (Freud ). But is free association therapeutic in and of itself? The author proposes an affirmative reply to this question based on the contribution of free association to the patient's nascent ability to shift between active and passive modes of cognition.

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.

My conversations with the superego and the ego: an experimental approach to psychotherapy technique

The author traces the history of superego theories in Freud's work and shows how latter contributions to psychoanalytic theory by Gray, the Novicks, and Arlow have provided theoretical foundations for innovative treatments in psychoanalytic psychotherapy. Arlow's insight into the continuous debates and discussions within our patients provides us with an opportunity to join in these discussions. Vignettes from two mildly obesssional male patients seen twice and twice a week provide demonstrations of this approach in psychoanalytic psychotherapy.

Introduction: babies in the consulting room: what happens when analyst, mother, and infant meet?

Analytic work with a pregnant woman may foster the psychological gestation of the self-as-mother. For the mother--as for the infant--the developmental process continues well beyond delivery. It should not surprise us, then, that many mothers continue to bring their babies to sessions after birth. Analytic work in this context can affect a patient's sense of herself, and perhaps her competence, as a mother. Yet the presence of babies in the consulting room is an underacknowledged feature of contemporary practice. For this section of JAPA, we have collected three papers that explore some of the unique challenges and opportunities that arise when a patient brings her baby to treatment. Earlier versions of each paper were first presented at a panel, "Babies in the Consulting Room," at the June 2011 meeting of the American Psychoanalytic Association in San Francisco.

Psychotherapy and close-process technique

The applicability and advantages of Paul Gray's concept of close-process in the practice of psychotherapy are discussed. Gray seems to have underestimated the potential and versatility of his technical approach to derivative psychotherapy procedures. Clinical vignettes are provided, describing some nodal points for intervention, and exploration of transferential, extratransferential and genetic aspects of the workable surface. Gray's methodology of intraclinical attention permits a more verifiable examination of sequences, an issue of special relevance in our age of empirical standards for the evaluation of dynamic therapies.

Technique and final cause in psychoanalysis: four ways of looking at one moment

This paper argues that if one considers just a single clinical moment there may be no principled way to choose among different approaches to psychoanalytic technique. One must in addition take into account what Aristotle called the final cause of psychoanalysis, which this paper argues is freedom. However, freedom is itself an open-ended concept with many aspects that need to be explored and developed from a psychoanalytic perspective. This paper considers one analytic moment from the perspectives of the techniques of Paul Gray, Hans Loewald, the contemporary Kleinians and Jacques Lacan. It argues that, if we are to evaluate these techniques, we must take into account the different conceptions of freedom they are trying to facilitate.

Ideas of influence: the impact of the analyst's character on the analysis

The fact that analysts inevitably analyze "in character" (i.e., as themselves) has been commonly assumed but unacknowledged publicly ever since Freud's Papers on Technique (1911-1915). Analysts' implicit private beliefs about the impact of their own characters on analytic work have been addressed obliquely via theorizing about the analyst's subjectivity and the role of mutually created resistances and enactments in the transference/countertransference matrix, but these views remain largely tacit. The author suggests that the psychoanalytic concept of character has run aground as a moral issue, not a theoretical one, and that its deeper role as the vehicle for unconscious action remains indispensable in analytic work. An extended clinical example is presented to illustrate the author's preliminary ideas about the impact of her own character in this analysis.

Paul Gray's narrowing scope: a "developmental lag" in his theory and technique

A cental thesis of Paul Gray's work is that a "developmental lag" pervades modern psychoanalysis in its failure to assimilate and apply knowledge gained about the role of the unconscious ego in intrapsychic life. But Gray himself, it is proposed, has become a victim of a new "developmental lag," of his own construction. As he somewhat single-mindedly pursued the ramifications of his "developmental lag" concept, Gray may have foreclosed on some noteworthy ideas developing around him. The most important example is his claim--herein refuted--that proper interpretive technique can avoid being infused with transference. He also seems to have rejected the theoretical importance of the internalization of the analyst and the clinical usefulness of countertransference. While emphasizing defense analysis, he ignores defenses such as splitting, denial, and disavowal as substantive problems for his technique of close-process attention. Gray's "undoing" of the rapprochement between "ego analysis" and "id analysis" by viewing the matter as an either-or proposition undermines the very real value of his contribution to the field.

Interpretive neutrality

Published clinical examples are used to show how both contemporary ego psychological approaches and the relational approach are pre-structural, in the sense that they implicitly appeal to Freud's earlier, layering model. In this framework, defense and defended-against are seen as categorically different, with the consequence that both interpretation and the goals of analysis are necessarily normative. Viewed in this perspective, interpretive neutrality represents an unrealistic absence of influence. This perspective can also account for the widespread pessimism regarding exclusive reliance on interpretation and the consequent belief in the need to rely on the impact of the analytic relationship.