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Publications in this journal

• On Guntrip's analysis with Fairbairn and Winnicott.

  Authors: H T Glatzer, W N Evans

  International journal of psychoanalytic psychotherapy. 6:81-98.

  Guntrip's paper is an account of his ananlytic experience, first with Fairbairn and then with Winnicott. Although attempting to be objective, he cannot disguise the fact that he is frustrated andGuntrip's paper is an account of his ananlytic experience, first with Fairbairn and then with Winnicott. Although attempting to be objective, he cannot disguise the fact that he is frustrated and dissatisfied. He raises this question: "How complete a result does psychoanalytic therapy achieve?" The question Guntrip is, in effect, asking himself, is: "What went wrong?" We suggest the following points: The failure of both analysts to recognize a very specific form of resistance and to deal with an unusual transference situation. Fiarbairn's insistence on giving oedipal interpretation to a patient who, as Winnicott recognized, did not have an oedipus complex. The failure of both analysts to recognize Guntrip's infantile megalomania; to expose his insistence that the blame for his neurosis must be attached to a "totally" bad mother; and the failure to recognize the intensity of his sibling rivalry. Psychoanalytic therapy is not merely "correct" interpretation and "correct" technique. It involves the interaction of two human beings. The countertransference of Fairbain and Winnicott prevented their perceiving and dealing with the essential problem of this exceptionally gifted patient.

• The therapist's use of metaphor.

  Authors: W H Sledge

  International journal of psychoanalytic psychotherapy. 6:113-30.

  A linguistic perspective is applied to the therapist's use of original metaphors in psychoanalytically oriented psychotherapy. I present a review of the literature along with a view of psychotherapyA linguistic perspective is applied to the therapist's use of original metaphors in psychoanalytically oriented psychotherapy. I present a review of the literature along with a view of psychotherapy and metaphor from a linguistic perspective. Three examples from psychotherapy are used to illustrate properties of metaphorical interpretations. An examination of the portion of the hour that precedes the therapist's metaphor suggests the importance of context in reducing the dangers of misunderstanding inherent in the use of metaphor.

• Transitional phenomena in the treatment of a psychotic adolescent.

  Authors: R P Fox

  International journal of psychoanalytic psychotherapy. 6:147-64.

  The clinical history and the initial phase of the psychotherapy of a hospitalized psychotic adolescent are presented to demonstrate the loss of "transitional capabilities" coinciding with the onsetThe clinical history and the initial phase of the psychotherapy of a hospitalized psychotic adolescent are presented to demonstrate the loss of "transitional capabilities" coinciding with the onset of a psychotic regression and their subsequent restoration as the patient reemerged from overt psychosis. Winnicott's concept of transitional phenomena is reexamined, highlighting its function in the capacity for illusion, its internalization as psychic structure, and its interpersonal dimension in the establishment of a "transitional mode of relatedness" within the psychotherapeutic situation.

• The treatment of a narcissistic disturbance in childhood.

  Authors: S A Frankel

  International journal of psychoanalytic psychotherapy. 6:165-86.

  This paper surveys four years of psychotherapy, beginning at age eight and a half, of a boy whose psychopathology appears to be a precursor of the narcissitic charater disorder described by KernbergThis paper surveys four years of psychotherapy, beginning at age eight and a half, of a boy whose psychopathology appears to be a precursor of the narcissitic charater disorder described by Kernberg (1975). The vicissitudes of the transference related chiefly to the patient's underlying narcissistic vulnerability. Interventions were generally aimed at demonstrating the relation of the patient's naricissistic (grandiose) defense to his underlying concern about devaluation by the therapist. The advantages of focuisng on such a patient's current needs and reactions are emphasized. The speed and success of the treatment of this child vis-a-vis adults with similar psychopathology is attributed to the relative ease with which his underlying needs (and related pathological envy, rage, and fear of retaliation) could be mobilized within the therapeutic relationship. This probably reflects the fact that his character defense was not yet fully entrenched. The contribution of normal development to the therapeutic process is also identified, as is the importance of both the real relationship and times of direct gratification of the patient by the therapist.

• Impotence, frigidity and depersonalization.

  Authors: W A Myers

  International journal of psychoanalytic psychotherapy. 6:199-326.

  A review of important psychoanalytic literature in the perplexing area of depersonalization focuses primarily on its phenomenology and genesis. Case material from two patients elucidates a relativelyA review of important psychoanalytic literature in the perplexing area of depersonalization focuses primarily on its phenomenology and genesis. Case material from two patients elucidates a relatively neglected, specific substate. These two analyses center about prominent complaints of impotence and frigidity which are seen as equivalents of, or screens for, underlying depersonalization. Only by understanding and working through the genesis of the masked depersonalization could these sexual dysfunctions be adequately treated. Depersonalization was also manifest outside the sexual sphere, but its presence there led to a more thorough elucidation of its etiology, in which actual childhood observations of the primal scene were of paramount importance. A comprehensive description of depersonalization phenomenology is offered which considers this state as a compromise formulation with contributions from each structure of the mental apparatus. Normal and pathological determinants of the sesation of a split within the self into observing and participating aspects are described, as is the genesis of feelings of alienation and estrangement.

• The psychotic character.

  Authors: L J Saul, S L Warner

  International journal of psychoanalytic psychotherapy. 6:243-52.

  A warp in the childhood emotional pattern may involve the ego and superego enough to cause psychotic elements or coloring, which may evolve into the psychotic character or into the potential for itA warp in the childhood emotional pattern may involve the ego and superego enough to cause psychotic elements or coloring, which may evolve into the psychotic character or into the potential for it or for psychosis. A brief review of relevant literature and a series of clinical vignettes are presented from the perspective of Alexander's model of the neurotic character. The psychotic is seen as showing: the dynamics of the neuroses acted out as in the neurotic character; narcissistic egocentricity and a failure of emphathetic, sympathetic identification and loving object relations; id impulses rationalized by a distortion of reality (manifested not in specific delusions, but rather, more diffusely throughout the ego); minimal or no insight into illness, as in criminality; and a failure of defenses against id impulse although the ego organization is intact. The clinical material reveals that these elements are encountered in all combinations and gradations; several types of psychotic character are discussed.

• Frightened men: a wish for intimacy and a fear of closeness.

  Authors: K H Blacker

  International journal of psychoanalytic psychotherapy. 6:270-88.

  Men who failed to achieve an adequate separation from their mothers are particularly prone to experience serious distress with their marriages during their middle years, when the wish for intimacy,Men who failed to achieve an adequate separation from their mothers are particularly prone to experience serious distress with their marriages during their middle years, when the wish for intimacy, coupled with a fear of closeness never resolved during infancy, is retriggered. An onslaught of biological, social, and psychological stresses force acknowledgement of previously denied needs for succor, plunging them into battle with their wife-surrogate mother. The resulting counterphobic, hypersexual, ofter self-destructive behaviors are usually falsely interpreted as oedipal. Clinical material in this report strongly suggests this distress is not primarily related to genital sexual issues or fears of castration, but more often concerns issues of autonomy and independence which typically involve the mother and which arose in the toddler or anal phase. Supportive evidence for this thesis from cross-cultural observations, child developmental studies, and primatology is presented, and the usefulness of this view in facilitating clinical work with such men is described.

• Transference phenomena in initial interviews.

  Authors: C P Adatto

  International journal of psychoanalytic psychotherapy. 6:3-13.

  Transference phenomena can be used effectively in pursuing diagnostic and therapeutic aims in initial interviews. Theorectical and clinical aspects of transference phenomena are discussed withTransference phenomena can be used effectively in pursuing diagnostic and therapeutic aims in initial interviews. Theorectical and clinical aspects of transference phenomena are discussed with special reference to preformed transference expectations, the dynamic and genetic aspects of transference, the differentiation of transference phenomena from transference and the transference neurosis, and their relevance to other analytic data. A case is presented, and two transference phenomena is the initial interviews are traced through later stages of the analysis; their origins and multiple determinants are demonstrated.

• The evolution of a shoe fetish.

  Authors: J W Hamilton

  International journal of psychoanalytic psychotherapy. 6:323-37.

  This paper deals with clinical material gathered from the long-term, psychoanalytically-oriented treatment of a patient with a shoe fetish. Genetic and dynamic aspects of this problem are emphasized.This paper deals with clinical material gathered from the long-term, psychoanalytically-oriented treatment of a patient with a shoe fetish. Genetic and dynamic aspects of this problem are emphasized. The combination of a dominating mother and a passive and absent father, the sharing of a bed with an older sister until age eleven, and the receipt of frequent enemas contributed directly to the development of the fetish, the most crucial determinant being the commulative traumatic effect of the enemas. During adolescence, the patient also resorted to transvestism to deal with the intensification of castration fears. Becoming a husband and father threatened to disrupt his tenuous defenses and forced him to seek therapy for two years, during which he was able to gain sufficient insight to forego the fetish and to engage in heterosexual activity in reasonably conflict-free manner. Previous theorectical contributions on the subject are included and theorectical issues are dealt with, particularly the role of the core fantasy of the phallic woman in the perversions.

• Prevention, infant therapy, and the treatment of adults: 2. Mutual holding and holding-oneself-up.

  Authors: J S Kestenberg, A Buelte

  International journal of psychoanalytic psychotherapy. 6:369-96.

  This is the second paper in a series of papers concerned with the relevance of infant therapy to the treatment of adults. The detailed presentation of a case of infant therapy illustrates our thesisThis is the second paper in a series of papers concerned with the relevance of infant therapy to the treatment of adults. The detailed presentation of a case of infant therapy illustrates our thesis that (1) early failures in mutual holding lead to a distortion of the body image, to an insufficient development of trust and empathy, and to a difficulty in holding-oneself-up and becoming self-reliant; (2) movement retraining of mother and infant is a method of choice to prevent the sequelae of holding failures; (3) insight gained from infant-therapy through movement retraining helps us understand adult patients whose body attitudes reveal their attempts to hold themselves up by putting strain on their neck, back, or shoulders; (4) the analysis of the defensive use of certain parts of the body for self-support reveals the underlying fear of falling, collapsing or falling apart.

• On lying fallow: an aspect of leisure.

  Authors: M M Khan

  International journal of psychoanalytic psychotherapy. 6:397-402.

  The capacity for lying fallow is discussed as a nonconflictual affective state and as a function of the process of personalization and growth. The qualities and achievements of the fallow mood areThe capacity for lying fallow is discussed as a nonconflictual affective state and as a function of the process of personalization and growth. The qualities and achievements of the fallow mood are indicated, as are the factors on which this state is dependent.

• Psychoanalytic notes on suicide.

  Authors: W W Meissner

  International journal of psychoanalytic psychotherapy. 6:415-47.

  The typology of and theories on suicidal behavior are reviewed to integrate various points of view in terms of the paranoid process. Freud's theory of internalized aggression, the relation of suicideThe typology of and theories on suicidal behavior are reviewed to integrate various points of view in terms of the paranoid process. Freud's theory of internalized aggression, the relation of suicide impulses to depression, the operation of narcissistic components in the complex motivation of suicide are related to the concept of the victim-introject as central to the pathology of suicide. Suicidal patterns play out the dynamics inherent in the victim-introject and its correlative component the aggressor-introject. The victim-introject serves as the core internalization around which a false-self system is organized; the suicide represents the attempt to destroy the false-self as a means of realizing the dynamic purposes of the victim-introject. The concept of the victim-introject integrates previous psychoanalytic formulations of suicide and provides a template for the development of a therapeutic rationale. Implications for therapeutic response are considered, particularly in terms of the need to undermine the patient's attempts to maintain and reinforce his victimization.

• The eroding concept of intrapsychic conflict.

  Authors: J W Slap

  International journal of psychoanalytic psychotherapy. 6:469-77.

  With the increased interest in borderline and psychotic patients, concepts are being introduced which erode the concept of intrapsychic conflict between the ego and the other macrostructures. InWith the increased interest in borderline and psychotic patients, concepts are being introduced which erode the concept of intrapsychic conflict between the ego and the other macrostructures. In particular, the drive derivative as source of danger is being lost sight of as expressions such as fear of the loss of ego boundaries and struggles against identification are introduced. Some authors who use these expressions, judging from their clinical material, do uncover their patients' fantasies and the drive derivatives and defenses they reflect. Nonetheless, they contribute to the problem by introducing inaccurate new terms. Other authors, having embraced recent innovations in theory, seem to disregard intrapsychic conflict.

• Lack of timing and ejaculatio praecox.

  Authors: E Guarner

  International journal of psychoanalytic psychotherapy. 6:315-22.

  Underlying factors in ejaculatio praecox are investigated through excerpts from the analysis of a man who suffered from this symptom for many years. The literature is reviewed, and the symptomUnderlying factors in ejaculatio praecox are investigated through excerpts from the analysis of a man who suffered from this symptom for many years. The literature is reviewed, and the symptom complex is related both to the patient's character structure and to the difficult resistances that he presented in analysis. The roles of the concept of time and of an inability to conceive completion are studied, as is the type of prevailing anxiety seen in these patients.

• Monologue, dialogue, and soliloquy.

  Authors: D P Eyre

  International journal of psychoanalytic psychotherapy. 6:65-80.

  Psychoanalytical therapy can be seen along developmental lines of three phases, the phases correlating with the early mother/child relationship which is reenacted in the transference relationship. AtPsychoanalytical therapy can be seen along developmental lines of three phases, the phases correlating with the early mother/child relationship which is reenacted in the transference relationship. At times one or the other of the phases can be totally permanent, but there can be alternation of the various phases both within a session and between sessions. Techniques implied for therapy are outlined and discussed, as the phases are explicated and related to Rickman's one-, two-, and three-or-more-body relationships.

• Visual imagery and defensive processes.

  Authors: M J Horowitz

  International journal of psychoanalytic psychotherapy. 6:99-112.

  The ideas and feelings that a patient usually avoids gain expression in therapy as words, images, or acts. The model presented of these representational systems conceptualizes defensive processes asThe ideas and feelings that a patient usually avoids gain expression in therapy as words, images, or acts. The model presented of these representational systems conceptualizes defensive processes as information processing decisions at the boundaries of particular systems and describes in detail the cognitive maneuvers that regulate image formation. Specification of these operations allows for acute observation and selective wording of the interpretation and direction on the part of the therapist that may help a patient override unconscious defenses by conscious choice.

• Symbiotic block with psychotic patients.

  Authors: D B Feinsilver

  International journal of psychoanalytic psychotherapy. 6:131-45.

  An impasse, which I term symbiotic block, occurs commonly in psychoanalytic psychotherapy with psychotic patients. Three cases, representing different levels of psychotic transference relatedness,An impasse, which I term symbiotic block, occurs commonly in psychoanalytic psychotherapy with psychotic patients. Three cases, representing different levels of psychotic transference relatedness, are chosen to exemplify this phenomenon. This impasse is defined in terms of undifferentiated symbiotic transference-countertransference phenomena which interfere with the separation-individuation process. The resolution process is defined in terms of concretizing issues of self-object differentiation and causality. A brief review of the literature is presented, along with discussion of the nature of the phenomenon and some key technical points.

• Countertransference aspects of pharmacotherapy in the treatment of schizophrenia.

  Authors: S T Levy

  International journal of psychoanalytic psychotherapy. 6:15-30.

  Emphasis is placed on largely unconscious aspects of the therapeutic relationship which determine the inappropriate or untimely use of psychotropic drugs, particularly on the therapist's response toEmphasis is placed on largely unconscious aspects of the therapeutic relationship which determine the inappropriate or untimely use of psychotropic drugs, particularly on the therapist's response to the regressive modes of relating and sharing emotional experience which characterize therapeutic work with schizophrenic patients. Case examples illustrate the use of drugs to establish interpersonal boundaries, to disavow frightening feelings within the self, and to renounce forbidden regressive pleasures-thus defending against the regressive pull of the developing symbiotic relationship. The effect of postpsychotic depression on the therapeutic relationship is explored with regard to the dynamics of psychotropic drug usage in treatment.

• Depersonalization in a female adolescent.

  Authors: R L Munich

  International journal of psychoanalytic psychotherapy. 6:187-97.

  This paper demonstrates the relationship between the onset and persistent manifestation of the depersonalization phenomenon in a femal adolescent. On the basis of a case report it is postulated thatThis paper demonstrates the relationship between the onset and persistent manifestation of the depersonalization phenomenon in a femal adolescent. On the basis of a case report it is postulated that certain external stimuli coinciding with anxiety lead to a physiologically induced altered state of consciousness which defends against the maintenance or repetition of these events. If the state functions effectively, as in the presented case, a symptom pattern develops which resembles very closely that altered state of consciousness. The particular form of the altered state is postulated to depend upon the personality configuration of the individual patient.

• Adverse response to neuroleptics in schizophrenia.

  Authors: D B Nevins

  International journal of psychoanalytic psychotherapy. 6:227-41.

  Negative therapeutic reactions to neuroleptics in schizophrenic patients are examined from the psychoanalytic perspective through case examples. Intrapsychic changes resulting from this medication,Negative therapeutic reactions to neuroleptics in schizophrenic patients are examined from the psychoanalytic perspective through case examples. Intrapsychic changes resulting from this medication, ordinarily considered beneficial, are shown, in some cases, to be disruptive of schizophrenic functioning and organization and potentially to endanger the continuation of medication itself. Changes are described which effect defenses, object relations, psychotic restitution, use of external reality, body image and cognition, and the symbolic significance of medication. Alterations in narcissistic ego states and disruption in preconscious processes, superimposed upon defective ego functioning, are used as explanatory concepts. These interact with transference based responses; in some cases, important psychodynamic issues emerge amenable to transference interpretations. Further study of intrapsychic changes may be useful in delineating a previously inexplicable response, understanding symptom formation, recognizing shifts in the patient-psychotherapist relationship, and forestalling premature cessation of medication.

• The alcohol induced hypnoid state and its analytic corollary.

  Authors: A Silber

  International journal of psychoanalytic psychotherapy. 6:253-67.

  Alcohol can be ingested to achieve a hypnoid state. This altered awareness is actively sought by the alcoholic as part of an ongoing attempt at mastery. By this symptomatic resort to a change inAlcohol can be ingested to achieve a hypnoid state. This altered awareness is actively sought by the alcoholic as part of an ongoing attempt at mastery. By this symptomatic resort to a change in consciousness, the painful affects connected with earlier assaults and seductions carried out by severely disturbed parents, are maintained in repression. At the same time this self-induced hypnoid state facilitates the gratification of both conscious and unconscious fantasies. The case history of a patient is reported who while in analysis, and on the analytic couch, evoked a hypnoid state. For this patient the analysis of this hypnoid state led to the recall and verbalization of early traumatic experiences. The similarity of early life circumstances, in regard to disturbed and inadequate parenting, in both the carefully studied analytic patient and the less frequently available data on patients treated by psychotherapy in an alcohol clinic is discussed.

• Alienation: character neuroses and narcissistic disorders.

  Authors: P L Giovacchini

  International journal of psychoanalytic psychotherapy. 6:289-314.

  Various defensive adaptations are described that patients with structural defects involving the self-representation (character neurotics) use to adapt to the external world, often achieving anVarious defensive adaptations are described that patients with structural defects involving the self-representation (character neurotics) use to adapt to the external world, often achieving an organization sufficiently stable to lead to considerable success. Externalization rather than projection is used. The differences between these two psychic processes are important for our understanding of character neurotics. Projection signifies placing impulses or parts of the self into external objects whereas externalization involves creating or finding a reality to support the defences, including projecting. The patient externalizes his infantile traumatic environment to construct a current world after his early environment which he finds both threatening and familar. Clinical material illustrates how the process of externalization operating within the transference context may lead to special technical problems. One type of character neurotic demonstrates a special type of externalization which supports overcompensatory feelings of self-aggrandizement, which are in effect, narcissistic defenses. To varying degrees, all character neurotics have some narcissistic defenses. Countertransference problems are also discussed.

• Countertransference.

  Authors: H Segal

  International journal of psychoanalytic psychotherapy. 6:31-7.

  Countertransference can be used as an instrument in understanding the patient's projective identification. An analogy for the patient/therapist interaction is found in Bion's model of the infant'sCountertransference can be used as an instrument in understanding the patient's projective identification. An analogy for the patient/therapist interaction is found in Bion's model of the infant's communicating by projection to the breast and the mother as containing and modifying such projections. The particular countertransference problems created by patients who have been objects of massive parental projections are examined. In such cases the patient's projections induce in the analyst diverse experience of past helplessness in relation to projections.

• Prevention, infant therapy, and the treatment of adults. 1. Toward understanding mutuality.

  Authors: J S Kestenberg, A Buelte

  International journal of psychoanalytic psychotherapy. 6:339-67.

  This is the first in a series of papers about the relevance of infant therapy to the treatment of adults. A description of maternal and infantile movement patterns is used to substantiate our thesisThis is the first in a series of papers about the relevance of infant therapy to the treatment of adults. A description of maternal and infantile movement patterns is used to substantiate our thesis that not only does the mother hold the child, but the child holds the mother. A good-enough holding environment is maintained when the mother's adult patterns of effort and shaping dovetail with the infant's inborn reflexes to make mutual holding possible. Mutual support enables mother and child attune in tension-flow rhythms (used for need satisfaction) and to adjust in shape-flow rhythms (used for intake and output). Attunement is the physical core of empathy, and adjustment is the cradle of trust. Empathy and trust between therapist and patient develop in a good-enough holding environment which is derived from mutual holding in early infancy. Not only does the therapist provide a holding environment for the patient, but the patient does his share to support the therapist in his aims.

• On neutrality.

  Authors: T L Dorpat

  International journal of psychoanalytic psychotherapy. 6:39-64.

  The various meanings of neutrality are traditionally assigned either to the psychoanalytic model, which developed within psychoanalysis, or to the natural science model whose meanings and methodsThe various meanings of neutrality are traditionally assigned either to the psychoanalytic model, which developed within psychoanalysis, or to the natural science model whose meanings and methods were imported from the observational methods of natural science. The rules of abstinence and anonymity and the analyt's respect for the patient's autonomy are the principal distinctly psychoanalytic meanings of neutrality. These are discussed and illustrated by case examples. Psychoanalytic neutrality is founded upon and regulated by ethical principles of truthfulness, personal freedom, and the analyst's caring commitment to the patient. The natural science model includes the inhibition of the analyst's affective reactions, the attitude of impersonal detachment, and the requirement that the analyst's evaluations and interpretations be value-free. It is nether possible nor desirable for analysis to adopt the neutral attitudes and techniques of the natural science observer.

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