"Someday ..." and "if only ..." fantasies: pathological optimism and inordinate nostalgia as related forms of idealization

Social Trauma, Nostalgia and Mourning in the Immigration Experience

Immigration and exile can qualify as social traumas. The individual is deprived of a holding, secure environment in which to continue their life. The process of mourning is a necessary step to connect with "going on being." Another psychic experience in migration is nostalgia; it helps the immigrant defend against the aggression resulting from current frustrations. The feeling of nostalgia can also be used to protect the ego from inadequacy. The complex components of nostalgia come from positive ones such as joy and gratitude connected with sadness about the associated loss of security, familiarity, and historical continuity. At other times, nostalgia cannot evolve, particularly in forced migration or exile. In this case, the individual enters a depressed state with accompanying feelings of self-pity, resentment, envy, and guilt, which prevents the mourning process from developing. To deal with these painful experiences, the person resorts to linking objects or linking phenomena that help them continue having contact with the past, while adjusting to their new environment.

A psychoanalytic view of reactions to the coronavirus pandemic in China

The coronavirus pandemic, which apparently began in Wuhan in December 2019, and has persisted to the present day, has had several psychological effects in China. The real danger has produced prolonged stress. Large-group phenomena have been stimulated. Overwhelming affects generated by the real danger have led to regression in the stimulus barrier (or "filter"). The COVID-19 has also triggered unconscious defensive reactions, including obsessional cleaning, counterphobic behavior, humor, and denial. The nationally imposed home quarantine of millions of families has caused in-home conflicts and neurotic repetitions of unresolved childhood issues. Prior psychiatric illnesses have been exacerbated. Health workers, including psychiatrists, psychologists, and psychoanalysts, have experienced emotional depletion. Finally, in families where there has been infection or death, delayed mourning and post-traumatic phenomena have been observed. In each of these situations, different interventions based on psychoanalytic principles have been useful.

Bring Me Your Hungers: Omnipotence, Mourning, and the Inexorable Limits of Time and Self in the Psychodynamic Treatment of Eating Disorders

Drawing upon the classic use of physical hunger as both a concrete sign of and metaphor for deep emotional needs, this article elaborates upon the many layers of hunger the eating disorder patient experiences and narcissistic defenses commonly employed to deny them. The authors use two extended case examples that illustrate the arduous but worthwhile task of welcoming patients to "bring their hungers"-an invitation that calls clinicians to make contact with the patient's human desires, to repeatedly chip away at the omnipotence used to mask such cravings, and to provide a space for working through the inexorable limitations imposed by time and mortality. A third example of a clinician who struggled with embodied countertransference reactions further elucidates different manifestations of these defenses. This paper highlights the unique value that psychodynamic clinical work offers patients in tolerating their healthy physical and emotional appetites to ultimately facilitate a more satisfying life.

The trauma and disillusionment of Oedipus

In the third day of his life Oedipus suffered a violent murderous assault in which his ankles were pierced so that he could be left to die. In fact, he was not only saved, but brought up as their son by the childless King and Queen of Corinth. My hypothesis is that a severe trauma left a significant physical and psychological scar, which was hidden beneath an illusion of a normal childhood. His background, including the cause of the infirmity of his ankles, remained obscure until it was revealed in the course of Sophocles drama. Facing the truth involved an exposure of the way an illusion had served to protect Oedipus not only from the truth of the murder and incest, but also of the fact that he had been severely traumatised. A phantasy of an ideal family commonly may serve as a defence against trauma and, as a result, facing the truth involves relinquishing the idealisation, and this may be experienced as a further trauma. In this paper, I will pay particular attention to the importance of guilt for the victim of early trauma. Severe trauma may block the acceptance of guilt and, hence, prevent the evolution of a benevolent cycle involving forgiveness and reparation.

Immigration, Psychic Dislocation, and the Re-creation of Community

Communities are "psychic entities" that serve powerful psychological functions for the individuals living within them. They also serve multiple functions, including as a potential space where individuals are "held" and within which individuals "play" in ways akin to Winnicott's formulations regarding how infants "use" the me-not-me zone of experiencing, the potential space created by the gap between symbiotic engagement and the maternal object, in a zone between desire for fusion and fear of disintegrating abandonment. This paper explores the psychic destruction of community and the attempts to reconstruct "usable" community in migration, drawing from Winnicott and other psychoanalytic theorists to help us understand how communities work as psychological spaces and, specifically, to understand the near universal clustering that we see in immigrant communities.

Looking ahead through a fragile lens: Vulnerable narcissism and the future self

Empirical data are lacking with regard to the degree to which self-absorbed hypersensitivity may be related to perceptions of the future self. The purpose of this study was to examine the relationship between vulnerable narcissism and several components of future orientation among psychiatric outpatients. A sample of 132 adult outpatients seeking mental health services completed measures assessing vulnerable narcissism, optimism, personal growth initiative and symptom distress, along with several questions regarding specific future outcomes. Correlation and regression analyses were used to examine relationships between vulnerable narcissism and future outlook domains, controlling for sociodemographic confounds and symptom distress. Significant negative associations were found between vulnerable narcissism and optimism, personal growth initiative, and expectations regarding mental health recovery and personal goal achievement. Clinical implications of these findings are discussed. Copyright © 2017 John Wiley & Sons, Ltd.

Effects of Affective Expectations on Affective Experience: The Moderating Role of Optimism-Pessimism

The Affective Expectation Model contends that affective expectations shape affective experience. Specifically, it argues that affective experiences are generally assimilated toward expectations when the two are congruent or when a discrepancy between the two is not noticed. When a discrepancy exists and is noticed, however, affective experiences should be contrasted from the expectation. Two experiments using psychology undergraduates (N s = 122 and 105) were conducted to test whether the individual-difference variable optimism-pessimism moderates these effects. It was hypothesized that optimists, because of their tendency to overlook contradictions, are less likely to recognize when an affective expectation is disconfirmed and thus often assimilate their affective reactions toward expectations. However, it was hypothesized that pessimists, because of their greater sensitivity to contradictions, are more likely to notice when an experience is discrepant from an expectation and thus often contrast their affective reactions from expectations. The results supported these hypotheses.

Patience

Patience is a multifaceted phenomenon consisting of acceptance of inner and outer reality, absence of resentment, retention of hope, and capacity to wait for better times without restlessness and haste. It originates in the childhood advance from pleasure principle to reality principle, though the attainment of secure attachment, object constancy, and frustration tolerance also contribute to it. Psychopathology involving patience generally manifests as endless waiting or chronic hurrying. Both the normative and morbid trajectories of patience have implications for psychoanalytic technique, which are illustrated here with the help of clinical vignettes.

Psychodynamic cultural psychiatry: a new approach to teaching residents

This article describes a course, Psychodynamic Cultural Psychiatry, taught to PGY-3 residents at the New York Presbyterian Hospital-Weill Cornell Medical Center that uses psychodynamic theory to help deepen cultural understanding. We (Sandra Park, the instructor for the course, and Elizabeth Auchincloss, the residency training director) developed the class in 2006 in an effort to raise cultural awareness in the residency curriculum. We believe that despite an inherent Western bias, psychodynamic theory can be an effective way to teach cultural psychiatry. Additionally, cultural understanding can enhance understanding of psychodynamic principles. In this article, we argue that our course in psychodynamic cultural psychiatry helps residents to integrate these two points of view.

Teaching supportive psychotherapy in the twenty-first century

Although supportive psychotherapy has had a long history in our field, relatively little attention has been paid to defining a body of material that residents should be taught in order to fulfill our current educational mandate. Teaching the evidence base for the efficacy of supportive psychotherapy is reviewed. The article then discusses three different conceptualizations of supportive psychotherapy--as comprising the fundamental elements of all psychotherapies, as one end of a spectrum of dynamic therapies, and as a distinct set of directly helpful therapeutic interventions. The importance of each of these perspectives to an integrated model of supportive therapy is discussed in the context of the teaching and training needs of psychiatric residents.

A randomized controlled trial of a feedback method for improving empathic accuracy in psychotherapy

OBJECTIVES

To develop and evaluate a feedback method for reducing empathic errors in psychotherapy.

DESIGN

Randomized controlled trial conducted in a university-affiliated out-patient psychiatric clinic.

METHODS

Sixteen non-psychotic patients treated for Axis I disorders by 12 psychiatry residents were randomly assigned to intervention and control conditions. In both conditions, at the end of each session, patients rated their own functioning on the Global Assessment of Functioning scale, and therapists predicted patients' ratings. Patients predicted their therapist's accuracy and therapists rated their confidence in their own predictions. In the intervention condition, therapists and patients reviewed their respective ratings from the previous session together. In the control condition, ratings were given directly to the investigator without being reviewed by either patients or therapists.

RESULTS

Therapists in the intervention condition showed greater overall accuracy than controls as well as evidence of increasing empathy later in therapy on the Barrett-Lennard empathy subscale. Patients in the control group perceived their therapists as significantly more or less accurate than was warranted according to the accuracy measure (over-/under-idealization). Therapists in the control group were more likely than those in the intervention group to overestimate their own accuracy (overconfidence). Affective responses to the instrument were positive overall and did not differ by condition.

CONCLUSION

An intervention such as the one tested in this study may be a practical and useful method for improving accuracy of understanding in a variety of training and clinical settings.

Self-criticism and unconscious grandiosity: transference-countertransference dimensions

The problems posed in understanding and working through the patient's layers of self-criticism are challenging for both patient and analyst. In particular, this paper explores some countertransference phenomena related to underlying grandiosity embedded in self-criticism. For patients who are self-critical, analyzing grandiose elements may create further grounds for self-reproach or open up new modes of self-experience and freedom. The paper tries to focus on how the analyst's experience of the patient's self-criticism often shifts over the course of analytic work. It is important for the analyst to not be crippled by a fear of considering the relevance of underlying grandiosity in relation to self-reproach. Understanding this dimension of self-reproach can help elucidate why it is so durable and refractory to interpretation. The patient has a stake in holding on to this self-punishment because it perpetuates self-regulatory fantasies. These fantasies sometimes relate to the feeling that the patient will be more successful or better loved by holding on to aspects of self-reproach. Sometimes these fantasies are based in competitive or dominant strategies related to winning out or retaliating over parents or siblings.

After hours: temporal developments at the edge of the analytic session

The author presents case material of a rigid, schizoid patient who at some point during his treatment began to come late for sessions. He once missed an entire session only to appear at the door after the scheduled hour had passed; this "timing" was evidently intentional. Discussion centers upon the meaning of this kind of phenomenon; it seemed that this particular patient was trying to remold the analytic frame, and the analyst's temporal experience, in accordance with a deeply primitive experience of the "shape" of time, and thereby carve out a sanctuary into which he could sequester his idiosyncratic sense of nontime until circumstances enabled further progress toward more mature symbolization of time.

From Fuzzy Logic Toward Plurimonism: The Science of Active and Empathic Observation

Plurimonism is a new philosophy and method of science. It holds that the revolution in computer science and artificial intelligence has reached the point that all the sciences in general can now account for the complex relations of an irreducible plurality of unique observers engaged in describing the same event. Plurimonism seeks to describe the conscious and unconscious relations of the scientific observer during the act of observation of a given event while preserving the historical uniqueness and indivisible identity of each such observer. Using the framework of plurimonism, we mathematically formulate the problem of empathy. This self-reflective mathematical model entails four components of the empathic process involving two observers. They are: 1) the self; 2) the self's-other; 3) the other; and 4) the other's-self. It measures the degree of accuracy of the therapist-observer's empathy, as well as conscious and unconscious processes involved in the patient-observer's idealization and the therapist-observer's confidence in clinical psychotherapy. Ratings are obtained from both patient and therapist from four different points of view. The plural views of the patient's global assessment of functioning (GAF) are from: 1) the therapist's view (TGAF); 2) the patient's view (PGAF); 3) the therapist empathic view (TEGAF), which represents the therapist's estimate of PGAF; and 4) the patient's empathic estimate of the TGAF. The GAF scale is the standard dimensional 100-point-scale measure used in psychiatry for recording a patient's functioning. The patient's estimate of the therapist's degree of accuracy as well as the therapist's confidence in his or her empathic accuracy is also represented. Three formulae are presented that describe the degree of the therapist's empathic accuracy, the patient's over-idealization/under-idealization, and the therapist's over-confidence/under-confidence. The concept of empathy is here restricted to mean the degree to which one observer can take the point of view of another observer when both are observing the same thing.

Forgiveness: origins, dynamics, psychopathology, and technical relevance

This paper integrates a diverse and scattered literature to describe the psychodynamic underpinnings of granting and seeking forgiveness. The evolutionary foundations and the developmental substrate of these capacities are elucidated. An individual who fails to make certain intrapsychic achievements may be vulnerable to psychopathological development, as is evident in those who cannot forgive or forgive too readily, constantly or never seek others' forgiveness, cannot accept forgiveness, or show an imbalance between their capacities to forgive themselves and to forgive others. The relevance of various developmental and phenomenological concepts to psychoanalytic technique, including the patient's need to forgive and to be forgiven, is also discussed.

From schisms through synthesis to informed oscillation: an attempt at integrating some diverse aspects of psychoanalytic technique

There exists a conceptual bifurcation at the core of psycho-analysis. It has been viewed from differing vantage points and portrayed as subsuming various dichotomies (oedipal-preoedipal, conflict-deficit, one person-two person, classic-romantic, and so on). While each such conceptual pair has its own heuristic accompaniments, these dichotomies share a profoundly important element. They have divergent effects upon the analyst's mode of listening and the nature of his or her interventions. These and other related technical implications are the topic of this paper. With the help of three clinical vignettes and by coalescing the isolated voices of many distinguished theoreticians, the author attempts to elucidate and heal this split. This paper proposes three levels of increasingly sophisticated resolution of the technical divergence resulting from this schism. The paper recommends an informed oscillation between the two polarities of psychoanalytic technique, an oscillation that must remain in consonance with the patient's shifting ego organization. The paper concludes by highlighting the developmental bases for the proposed technical conceptualizations.

The wish to regress in patient and analyst

The analyst's wish to regress is used as a paradigm of the "forbidden" topic of what analysts want from their analysands. The aim is to expand the subjective domain of analysts' awareness so that they can analyze better by grasping more of their temptations with patients before enactment can occur. Clinical examples illustrate how the author temporarily joined patients in wish-fulfilling mutual regression. Analytic process is disrupted when the analyst wishes to relinquish the more differentiated role of the containing and interpreting analyst in favor of more childlike relatedness both with the patient and with the analyst's internal objects. The author, expecting a more typical counter-transference, had not anticipated that he might temporarily join these nonpsychotic patients in mutual regression. It is suggested that in the face of analytic impasse analysts should consider whether they might temporarily have joined the patient in mutually regressive wishes that have taken them away from more responsible analytic functioning.

The future of optimism

Recent theoretical discussions of optimism as an inherent aspect of human nature converge with empirical investigations of optimism as an individual difference to show that optimism can be a highly beneficial psychological characteristic linked to good mood, perseverance, achievement, and physical health. Questions remain about optimism as a research topic and more generally as a societal value. Is the meaning of optimism richer than its current conceptualization in cognitive terms? Are optimism and pessimism mutually exclusive? What is the relationship between optimism and reality, and what are the costs of optimistic beliefs that prove to be wrong? How can optimism be cultivated? How does optimism play itself out across different cultures? Optimism promises to be one of the important topics of interest to positive social science, as long as it is approached in an even-handed way.

How to help patients (and analysts) bear the unbearable

Psychoanalytic techniques are explored through which analysts can help patients tolerate, face, and attempt to resolve affects and conflicts that have seemed unbearable to the patient. The patient's feeling of "I can't" is differentiated from the feeling of "I won't." Process material focuses on patients' shifts between seeming inability to function as analytic collaborators and more responsible ownership and exploration of conflict. Analysts' either/or attitudes toward analyzability tend to interfere with flexible shifting between times when they can interpret and prolonged periods when they cannot interpret and the patient cannot collaborate. During the latter, the analyst needs to provide some noninterpretive function, such as holding, containing, or affirming, both for the patient and for him/herself.