Psychoanalytic Inquiry

Published by Taylor & Francis (Routledge)
Online ISSN: 0735-1690
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Article
This chapter describes outcome research in child psychoanalysis that was conducted by the Anna Freud Centre (formerly the Hampstead Clinic). The early research includes a series of studies (P. Fonagy and G. S. Moran; 1991, 1994) of psychoanalytic treatment with children suffering from so-called brittle diabetes. In ongoing work, a retrospective chart review was conducted of 763 cases already treated at the Anna Freud Center in either four-to-five times per week psychoanalysis or one-to-three times per week psychodynamic therapy. Three main studies using closed case records are reported: emotional disorders (M. Target and P. Fonagy, 1994); disruptive disorders (P. Fonagy and M. Target, 1994); and developmental considerations (M. Target and P. Fonagy, 1994). The establishment of a prospective study of treatment effectiveness in child psychoanalysis is described, including problems of outcome measurement, specification of treatment technique, and monitoring of treatment integrity. Preliminary results are given from an ongoing follow-up study that predicted considerable differences in outcome between individuals treated at the Anna Freud Centre as children, their siblings, and a further group of untreated, referred children with apparently similar psychopathology in childhood. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Article
Derived from the Boccacio tale of Diamora and Ansaldo, Bertolucci's elegant chamber work Besieged involves a British piano teacher who falls in love with a young African medical student who lives in and cleans his house. When he learns that she is married to a political prisoner in Africa, he sells his artwork in response to a challenge to ransom the husband from prison. Of this unconventional love story, Bertolucci said that the film represents Cocteau's adage, "There is no love, there is only proof of love." It ends with her struggling with choosing between the two men in a beguiling ambiguity. The discussion explores many aspects of altruism within a love relationship.
 
Article
Cinema and time have complex structural connections, but only a few movies have focused specifically on them. A remarkable exception is a series of shorts by 15 major film directors, collected under the title Ten Minutes Older (2002). I shall refer here to one of such films, Bernardo Bertolucci's Histoire d'Eaux. Narada, an Indian immigrant, has a chance encounter with an Italian woman, and we watch their lives unfold over the years. But at the end of the film, Narada goes back to the old man who has been waiting for a drink of water since the time preceding Naradaâ-™s first meeting with the woman, as if only a few hours had gone by, instead of a lifetime. This narrative, taken from an ancient Eastern parable, offers the opportunity to comment on the merging of different temporalities in human experience, with specific reference to psychoanalytic interpretations of our relationship to time.
 
Article
I revisit Freud’s case of Dora from the vantage point of current literary and psychoanalytic perspectives. Mahony (this issue) argues that Freud’s understanding of Dora is unconvincing to the modern reader because Dora is a victim of trauma rather than sexual repression. I extend Mahony’s ideas in terms of the development of psychoanalytic ideas, place Freud’s view in the context of my psychoanalytic education in themid-20th century, and suggest that modern contributions to trauma theory and memory further support the thesis that Dora was a victim of trauma rather than of conflicted libidinal desires.
 
Article
Trauma impels people both to withdraw from close relationships and to seek them desperately. The profound disruption in basic trust, the common feelings of shame, guilt, and inferiority, and the need to avoid reminders of the trauma that might be found in social life, all foster withdrawal from close relationships. But the terror of the traumatic event intensifies the need for protective attachments. The traumatized person therefore frequently alternates between isolation and anxious clinging to others [Herman, 1992, p. 56].
 
Article
This paper examines how early attachments, trauma, and transference are modified by cross-cultural issues in a group therapy setting. The paper focuses on preparation of an appropriate group after individual treatment, attention to composition in that group, and use of a female –male cotherapist team in helping two Latin American female group members work through their early traumas. In addition, the paper speaks about times when individual treatment with the group therapist of the opposite sex should be added. The paper emphasizes and clarifies how not to get caught up in cultural stereotypes and how the clinician needs to stay with the specificity of the person’s organizing experiences.
 
Article
The pair group provides a powerful and most useful regulatory function for adolescents. A group-based approach aims to create an intersubjective field in which an adult group conductor and the individual group members interact with the complex dynamics of the pair group. The author maintains that the core task in her approach is to understand and follow the pair group and help it learn to self-regulate and self-organize so that each member becomes aware of the affective meaning of “belonging to the group system.” The groupmembers thus develop the ability to explore new ways of relatedness—with self and others—through coconstruction of an environment of shared intimacy and safety. Clinical vignettes illustrate an approach that aims to strengthen affect regulation in young adolescent groups in the public school setting.
 
Article
For most women, their relationship with their mothers, both external and internal, remains important throughout life, although it may be intensely ambivalent. The tension between the ongoing process of differentiation and developing a sense of self, and also maintaining the attachments that have been present during development into adulthood, continue to be present, fluctuating with life events and changes for both daughters and mothers. The body with its similarities to the mother, mutual identification, and competitive aspects is a central area for experiencing this relationship. A patient who illustrates these processes is described.
 
Article
In 1971, Heinz Kohut, trained in neurology and then psychoanalysis, published The Analysis of the Self, a detailed exposition of the central role of the self in human existence. This classic volume of both twentieth century psychoanalysis and psychology was more than a collection of various clinical observations—rather it represented an overarching integrated theory of the development, structuralization, psychopathogenesis, and psychotherapy of disorders of the self. Although some of these ideas were elaborations of previous psychoanalytic principles, a large number of his concepts, including an emphasis on self rather than ego, signified an innovative departure from mainstream psychoanalysis and yet a truly creative addition to Freud’s theory.
 
Article
This paper describes the importance of a clinical focus on affect and narcissistic vulnerability in the deepening of therapeutic process. An experience of the analyst’s emotional availability and understanding is also essential to mutative change. The case material illustrates how such a focus, within a relational context that includes the analyst’s own vulnerability, can lead to change.
 
Article
The concept of the representational world, first devised to accommodate the research data of the Hampstead Index and intended to supplement the structural point of view, has since expanded into a central conceptual tool of contemporary psychoanalysis. As developed by the Sandlers, affective states and experiences are the core of all mental representations, giving psychological meaning, force, and direction to the objects represented. The emphasis on affective components, conscious and unconscious, has enriched psychoanalysis by fostering communication with neighboring disciplines. A clinical vignette illustrates the embeddedness of affective valences in internal representations.
 
Article
Over the past 20 years we have formulated a model of early ego Odevelopment that integrates biological differences, develop-mental stages, interaction patterns, and wishes and affects. Our approach to assessing and intervening with children with autistic spectrum disorders is based on this model, which emerged from work with infants, young children, and their families. Understanding early ego development served as a foundation for a therapeutic program that has enabled a subgroup of children with autistic spectrum diagnoses to become engaging, communicative, verbal, creative, and empathetic (Greenspan and Wieder, 1977, 1998; Greenspan, 1992a). Applying developmental concepts in clinical work has also suggested a core psychological deficit in autistic spectrum disorder and the components of a comprehensive approach to intervention.
 
Article
Levenkron begins with the thesis that the analyst is never outside of enactments between herself and her patient. The analyst must enage these enactments with affective honesty, and this must be done during the sessions within which the events in question occur (i.e., in the heat of the moment, without necessarily being able to formulate the relevant unconscious meanings). Levenkron's contribution is her recognition of the necessity for the confrontation created by the analyst's affectively honest reaction to the attempt by both the patient and herself to force the relationship along certain paths.
 
Article
Anchoring her views in the work of Benjamin and other American relational authors, Levenkron asserts that intersubjective relatedness in which there is recognition of separate realities is essentially the only form of relatedness. Framing growth as coming about through the recognition of another's subjectivity provides a basis for "confrontation" and for a more direct injection of the analyst's subjectivity into the analytic encounter. More specifically, it fosters the expression of the analyst's subjectivity from what this author calls the "other-centered" and "self" perspectives. In contrast, the recognition of selfobject and caretaking relatedness positions the analyst to express directly aspects of the analyst's subjectivity pertaining to mirroring, idealizing, and twinship selfobject needs. Kohut and classical self psychologists have delineated selfobject needs and the selfobject dimension of relatedness and transference and have emphasized the consistent use of the empathic listening/experiencing perspective. American relational theorists have delineated intersubjective relatedness and the usefulness of the other-centered listening/experiencing perspective. This author focuses on an integrative theory including three forms of relatedness and different listening/experiencing perspectives. Different listening/experiencing perspectives and forms of relatedness fundamentally influence analysts' affective experiences within the analytic encounter as exemplified in Levenkron's case.
 
Article
In my discussion of Levenkron's article, I consider ways of understanding the patient's therapeutic progress that were not highlighted by the author. Adding my own criteria to Levenkron's definition of enactment, I suggest that what the author labels as enactment might be seen as a last-ditch but successful effort to get patient and analyst out of a stuck and painful place. I explore the interplay of confrontational and nonconfrontational interventions in contributing to cure, and I suggest placing a greater emphasis than did the author, on the intersubjective contexts out of which the patient's troublesome behaviors emerged.
 
Article
This case describes the treatment of a middle-aged woman with a history of extreme physical and sexual abuse seen in psychoanalytic psychotherapy two and three sessions per week. Dissociation and enactment are two salient features of the therapy. Detailed clinical vignettes that occurred over the eight-year period of treatment highlight co-created sequences involving intensified affective moments experienced by the analyst as often challenging, perplexing, and surprising. I have never worked with a patient as denigrated, as humiliated, as falsely blamed, and as sexually and physically abused as Ann. We are still working together, so you are hearing work in progress. This is not only Ann's story as I understand it, but it is also my story of experiences that Ann and I have co-created together. Naturally, Ann would have her own version.
 
Article
Using transcripts of clinical cases, the author seeks design clues for the building of a holding environment. The transcripts present a picture of an interpersonal situation rife with mistrust, confusion, dread, instability, fragmentation, vagueness, menace, difficulty, and doubt.
 
Article
This article is a personal account of the evolution of one analysts thinking about dissociative identity disorder (or multiple personality disorder). I included some of my personal experiences in undergoing this paradigm shift because I believe many other psychoanalysts and psychotherapists experience similar questions and dilemmas when they encounter patients with this disorder in their clinical work. Many bitter but false dichotomies accompany this disorder. As Rangell has observed, analysts tend to dichotomize intrapsychic versus traumatic etiologies. The dissociative paradigm richly supplements, but does not supplant our analytic understanding of etiology and treatment. Among the clinical examples that I include is material from my work with a severely psychotic patient that raises questions about the dividing line between dissociative identity disorder and schizophrenia.
 
Article
In this article, I give an overview of a contemporary Freudian theory of the analytic process. In this theory, the concept of analytic trust is a central component of each phase of the analytic process. Each phase of the treatment is conceived of as a series of transference cycles (Freedman and Lavender, 1997), and during each cycle there are both necessary ruptures and repairs that either endanger or facilitate the transition to the next transference cycle. Gradually, as love develops between the analytic pair, the ruptures that occur in the transference cycles are more easily endured. As love develops, the survival of the analytic pair is less and less of an issue. In addition, the necessary ruptures that occur in transitions between the transference cycles are also more easily endured. Surviving each rupture enhances analytic trust and deepens the love between the analytic pair. The theory borrows and attempts to integrate aspects of several positions, including self-psychology, Winnicott, Klein, and Bion. Although it is my view that what I ampositing is important for all analytic patients, in this article I focus on two types of patients, narcissistic and borderline patients.
 
Article
This response to the discussions in this issue of Psychoanalytic Inquiry illustrates the use of symmetrical or unconscious logic and asymmetrical or conscious logic in “A Case Study of Power and the Eroticized Transference-Countertransference.” The analytic relationship is described as a developmental process which uses presentational symbols, enactments, and transitional experiences as a means of transforming the patient’s disowned and frightening experiences of destructiveness, aggression, power, and sexuality into an integrated and pleasurable experience of power and sexuality. The two sessions are used to illustrate this process of transformation. I then discuss the five discussions of my case material in terms of the use of symmetrical and asymmetrical processes as well as how each approached the uniqueness of the patient’s history and dynamics.
 
Article
The author seeks to engage a dialogue with Casement regarding his premises and his rationale for withdrawing his agreement to allow Mrs. B the possibility of holding his hand. While not quarreling with Casement's handling of the treatment, the author questions whether he indeed arrived at his retraction by "listening to the patient." The author addresses Casement's one-person psychology, wherein potential space lies intrasubjectively within the patient's associations and the analyst's private consultations with his internal supervisor, and contrasts this framework with a more two-person, or intersubjective, view of potential space located between the two persons in the consulting room. To this end, contributions by Bach and McLaughlin are considered and the author offers a clinical illustration from her own practice.
 
Article
Analytic positions are defined as viewing perspectives. Therefore, an analytic position determines one's field of observation. Two families of affect theories in psychoanalysis are then identified: the Darwinean and the Aristotelian. Affect has been addressed as either an energic like charge along a gradient or a form of communication. Each swims into focus when viewed with respect to the position of the observer as either inside the clinical interaction or outside the transference. How each is observed then determines different implications for interpretation, transference, reconstruction, and defense analysis. How the mind itself is modeled in theory is seen to follow from how observers position themselves. Choosing an observational field cannot be avoided. How an analyst in a clinically meaningful way might think about such disparate fields is taken up.
 
Article
The author writes a discussion of Judy Pickles's case description drawing on his control-mastery perspective. He views the ubiquitous dramas that characterize this analysis as challenges to the patient's pathogenic beliefs, taking the form of implicit questions through action and interaction. The questions relate to salient themes in this patient's traumatic lived experience with others, recontextualized and worked through in the analytic situation.
 
Article
Recent thinking from the Boston Change Process Study Group is brought to bear on considering the case of Ann. The importance of considering the moment-to-moment interactive exchange is emphasized. The prominence of dissociation is discussed, as is special consideration of the dynamic of being unknown as it affects the therapist and the treatment.
 
Article
From the end of the Second World War until now, several movies on the world of adolescence have represented the complexity of adolescence, focusing on sociocultural developments and inter- and intrapsychic changes. Due to the great amount and variety of movies about adolescence, it is very difficult to offer a complete and exhausting overview. In this paper, the authors have, therefore, focused their attention on the works of two Italian film director generations that have faced such a complex subject, that of childhood and adolescence, through different levels of depth and language: Luigi Comencini (1916) and his daughters, Cristina (1953) and Francesca (1961), and Dino Risi (1916) and his sons, Claudio (1948) and Marco (1951). The works of the fathers represent the evolution of the Italian neo-realism of the period following the war towards comedy, endowed with dramatic elements, a fecund, rich, intense, and creative moment of Italian cinema. The following generation tries to distinguish itself in a period of hardship for the Italian cinema that offers little variety of successful authors. Risi's sons and Comencini's daughters seem to concentrate on a personal research, between the continuation of their fathers' works and the emancipation. This foreshorted view of Italian movies offers a starting point for a discussion about historical evolutions, intergenerational relations, transgenerational transitions, and peculiarities of the above-mentioned film directors.
 
Article
As neuroscience research has uncovered the genetic/biological basis of obsessive-compulsive disorder (OCD), a broad consensus has been reached that behavior therapy and a selective serotonin reuptake inhibitor are the treatments of choice for the condition. Nevertheless, psychoanalytically informed approaches still have much to offer in an overall treatment plan. The biologically determined symptoms have unconscious meanings to the patient that may lead the patient to be highly invested in maintaining the symptoms. Also, psychodynamic factors may be involved in triggering an exacerbation of the symptoms. Moreover, the compulsions and obsessional thoughts almost always have interpersonal meanings that need to be addressed. Family members and others, including treaters, may feel compelled to accommodate themselves to the illness as a response to coercive behaviors by the patient. Finally, the characteriological features of individuals with OCD tend to undermine treatment efforts in many cases and may require psychoanalytically informed therapy to deal with them.
 
Article
Combining a psychoanalytic and personal perspective, I discuss my choreographic process during the creation of my solo Splinter of Hope. I explore the impact of my subjective relationship to my embodied aesthetic, family, and cultural history, and Anna Ornstein's book My Mother's Eyes: Holocaust Memories of a Young Girl. I show how the choreographic journey is analogous to Daniel Stern's descriptions of "present moments," "now moments," and "moments of meeting." Significantly, my feelings of trauma in response to the horror of the Holocaust and my quest for the hope of restoration are addressed through artistic processes, exploring joy, trauma, and the transformation of ugliness into beauty through integration.
 
Article
Four important themes in self psychology as developed by Heinz Kohut are remarkably congruent with current theoretical constructs in the field of evolutionary (Darwinian) psychology: (1) the concept of narcissism, (2) the claim for the innate human capacity for empathy, (3) the recognition of the importance of group cohesion, and (4) the belief that individual psychological distress is produced by a changed environment rather than a dysfunctional self. By recasting Kohut's themes in a Darwinian framework and interpreting them with personal views of the phylogenetic origin and nature of the arts (Dissanayake, 2000), I describe and make clear the central importance of art experience to the developing selfobject relationship as well as to the evolution of the human species.
 
Article
Autism, a serious developmental disorder that presents in children Abefore the age of three, has a history of diagnostic confusion, prognostic uncertainty, and a never-ending array of treatment options. It is not at all unusual for parents to receive conflicting diagnoses if they take their atypical preschool child to several different professionals. Autism, nonautistic pervasive developmental disorder (PDD or PDD-NOS), mental retardation, developmental language disorder, attention deficit with or without hyperactivity, emotional disturbance, or static encephalopathy may be diagnosed--all in the same child. No wonder the parents are perplexed, frightened, and, in most instances, devastated. After receiving a diagnosis of autism, parents are faced with the twin dilemmas of where to turn for a fuller understanding of this disorder and how to decide which kind of treatment would be best for their child. The choice of treatment is, of course, critical, and there are many options to choose from. One could, for example, select a behavioral therapist; a school or clinic that serves children with developmental disabilities; a professional who believes that the autistic behaviors are caused primarily by sensory disturbances, allergies, or an imbalanced metabolic system; or even a psychoanalytically oriented psychotherapist. Each of these choices would involve radically different treatment options. Perhaps even more important, the role of the parents in each of these treatments would vary dramatically. The focus of this paper is on a therapeutic nursery model for intervention with autistic and other developmentally disordered preschool children and their parents. This model has evolved over the past 20 years, during which time we have worked intensively with several hundred families and actively participated in developmental disabilities research. In the following section, we place our intervention model within the context of other types of intervention that may be offered.
 
Article
Most people who come to our offices can handle the paradox that there’s more inside of them than they can put into words—“more than meets the eye”—without intrinsic emotional isolation. They can be both in the world and separate from it as a unitary self-experience. Some, however, experience their private inner world and their engagement with day-to-day life as separate and totally unrelated events, each in its own way an exhausting labor of emotional survival. Much of the therapy involves the creation of transitional space that can embrace both otherness and selfhood, and for such patients the analytic process triggers an internal war between inharmonious aspects of self into which the analyst is inevitably drawn. Regardless of diagnosis, patients in this group are most often the ones we experience as “difficult,” and pretty much from the beginning of my career I was drawn toward working with so-called difficult patients. My appetite for it doesn’t seem to have abated. I continue to learn the most from individuals whose declaration that “there’s more to them than meets the eye” is for one part of the self a battle cry and for another a plaintive cry to be known.
 
Article
Joseph Lichtenberg suggests that infants are held in their caregivers’ symbolic world before they create one of their own. This idea is addressed from the perspective of parental reflective functioning. This construct offers a means of further understanding how a caregiver’s capacity to elaborate upon the mental life of her child sets the stage for the child’s internal experiences becoming known and developed or distorted and stunted within the context of the relationship. These ideas both complement and expand upon the research and theoretical work described by Lichtenberg in his consideration of the development of communication with self and other in infancy.
 
Article
The author discusses Judith Pickles's case "Alone Together" from a self psychological forward edge perspective. The importance of the forward edge focus is delineated not as a replacement for but as an addition to the more traditional repetitive edge focus.
 
Article
This paper argues for a radical relational perspective that explicitly challenges the notion of the intrapsychic and the related Cartesian assumptions of representationalism. Conceptual tools derived from the school of embodied cognition provide an alternative theoretical language that depicts a new understanding of experience as an emergent and distributed phenomenon of a dialogic communicative system. Clinical vignettes illustrate how this new ontology of experience promotes a therapeutic ambience that dissolves the barriers to empathic contact imposed by the retention of representational modes of thought.
 
Article
The psychoanalytically informed treatment of dissociative identity disorder (DID) involves the utilization of treatment methods and models relevant to the treatment of this condition within the matrix of an overall psychoanalytic orientation. Dissociative defenses and structures constitute an "elsewhere thought known" which is not unconscious, but which comprises simultaneously ongoing trains of mental processing. Failure to address these processes and the alters that express them is analogous to allowing the keeping of secrets in psychoanalysis -- a collusion to leave crucial material, conflicts, and dynamics unexplored. The alters may be understood as desperate efforts to disavow and mitigate the impact of overwhelming life events. They express and embody the wish to supplant intolerable realities with more tolerable ones. Working with the alters is essential to the therapeutic alliance with DID. Clinical issues involved in doing psychoanalytic psychotherapy with DID patients are discussed, and modification s of technique that allow bringing the contributions of the alters into the therapeutic process are explained.
 
Article
In this essay, I focus on how my personal history contributed to my choosing to become a psychoanalyst, what I then encountered and the choices I made professionally, and the issue of being “inside” versus “outside” the classical tradition. In this context, I describe some of the political conditions that prevented Ph.D.’s from being able to be trained as analysts within the classical tradition during those years. I also describe how the training I received outside the classical tradition actually was much broader than what would have been offered within it and how it allowed for a level of intellectual freedom and critical thinking about traditional ways of working that would not have been possible in the classical institutes. I also describe briefly how I began developing the concept of working at the “intimate edge” in the analytic relationship, which I first began writing about in 1974 and which is detailed most fully in my 1992 book, The Intimate Edge: Extending the Reach of Psychoanalytic Interaction, and in several subsequent publications (Ehrenberg, 1995, 1996, 2000, 2003).
 
Article
Recent studies of eyewitness testimony have shown, beyond a doubt, that memories for recent events can be permanently affected by subsequent comments or intervening thoughts. This kind of contamination is further amplified by the fact that analysts are trained to listen between the lines and to always be alert to what is not said. Many of the associations we become aware of during an hour can easily become part of our recent memory and soon after, part of the record. For these and related reasons, it seems more than a little unwise to rely solely on memory-based reporting, and analysts need to find more evidence-based methods of recording our clinical encounters. Ways must be found to be faithful to what was said as filtered through the analyst's context of consciousness and make explicit how this understanding leads to the next intervention. A fully unpacked vignette can become our version of evidence-based reporting because it takes away the mystique of the unseen Unconscious and exposes the rationale behind our procedures. Truth by coherence becomes a substitute for truth by correspondence.
 
Article
Through an analytic reading of the 2 films by Elizabeth Marton and Roberto Faenza, we revisit the relationship between Sabina Spielrein and Carl Gustav Jung, focusing their attention on the contribution it gave to the development of the concept of transference and countertransference. Elisabeth Marton's film is more linked to the historical documentary, and Faenza inserts historical documentary in a fictional frame, bringing the spectator towards the affective, passionate level of this analytic relationship of the beginning. In the history of psychoanalysis, the therapeutic and love encounter of Spielrein and Jung represents the first attempt to testify the sufferings and errors, suffered by the 2 protagonists; they supplied the basic elements for the reflection and research of contemporary psychoanalysis on the theme of transference/countertransference.
 
Article
Self psychological and relational models are so complex and well articulated, they have such rich clinical implications that it would be impossible to comment or compare them in any depth in this discussion. Therefore, my comment will deal only with two particular issues that I consider very important in contemporary psychoanalysis: identification and aggressiveness, constructs that are important in both Black's and Tolpin's models and that implicate the analytic stance deriving from their respective theoretical assumptions. I will also comment on something that I consider a very powerful factor in Pickles's case: Annâ-™s birth to a dead mother.
 
Article
Girls and women are disproportionately affected by chronic pain unrelated to medically defined disease. Because the mother-daughter relationship is pivotal in female development, one can speculate that chronic pain could be entangled with and expressive of the mother-daughter relationship. I describe two women who came for treatment with chronic pain and other psychosomatic manifestations as the primary symptoms. Both experienced profound trauma and had deeply conflicted relationships with their mothers, in which reflective function and symbolic capacity were stunted, resulting in a physical language.
 
Article
Using Casement's paper on touch as a springboard, I explore the notion of touch or contact in the analytic setting. I also briefly revisit the historical context within which the debate on touch occurs, and examine the rule of abstinence, which has long prevailed in psychoanalysis. The ability to focus on the patient's individual needs and tolerances, as well as one's own boundaries, limits, and comfort in this area, may deepen and enhance the psychoanalytic experience for both patient and analyst. To illustrate my premise, I focus primarily on my work with two analytic patients, one for whom some sort of touch was indispensable for continuation of treatment, the other for whom it would have meant the destruction of the analysis.
 
Article
Written from a developmental systems self psychology perspectives, in this paper all questions of boundary, including that of touch, are conceptualized contextually as emerging from within a particular psychoanalytic dyad and shaped by it.
 
Article
In this essay, I imagine what Dora’s second analysis would have been like had she come to see me many years after her first analysis with Freud. To contextualize Dora’s “second” experience (aided by my knowledge of Freud’s analysis and his ideas about the nature of Dora’s problems), I picture what she would have presented to me and how my understanding of her selfobject transference would have guided me in listening to her subjective experience. Dora’s manifold fears of rejection and the many ways in which these now reappeared in the transference guided the interpretive process. But the traumatic experience occasioned by the fact that Freud essentially dismissed her desperate efforts to gain acceptance for her version of what happened between her and Herr K at the lake seemed to have been put to rest. Having been listened to engaged Dora emotionally in this second analysis and appreciably eased her current difficulties.
 
Article
This account of the author’s psychoanalytic education and the subsequent evolution of his theoretical and technical beliefs emphasizes his sustained attachment to classical Freudian principles. The refinement of his views consequent to his close friendship and collaboration with Charles Brenner is described. In recent years, his study of the work of certain colleagues who are exponents of other psychoanalytic points of view has resulted in some modulation of his technical stance, without altering his fundamental convictions about the nature of the psychoanalytic enterprise.
 
Article
I present an aspect of my version of modern drive theory with a preservative and a sexual drive as basic motivating factors in mental life. To consider self-preservation and object preservation as primal drive activities allows me to focus on the many issues of caretaking as they play a major role between mother and daughter. I discuss three different ways that mothers deal with object-preservative concerns in the interaction with the child with regard to competition and rivalry. An extended psychoanalytic example demonstrates how I use these concepts in my clinical work. The article ends with some reflections on specific countertransference difficulties in the context of self-preservative and object-preservative urges and needs.
 
Article
The conception of OCD as a brain disease, as it is presented by Dr. Judith Rapoport, is refuted by clinical evidence. This evidence shows obsessive-compulsive symptoms to emerge from a variety of rigid, that is, rule-directed, character. All the well-known obsessive and compulsive symptoms can be derived from character of this sort, in particular from the special, rigid conscientiousness that is its central feature. Deficiencies in the psychoanalytic understanding of symptom formation weaken its case against the reductionistic conception of OCD.
 
Article
I argue that the entry into the triangular "oedipal" situation for girls does not necessitate a change in object, as Freud proposed, but an addition of object. My argument rests on different strands in contemporary psychoanalytic thinking: an appreciation of the complexity of internal objects, a reconsideration of the concept of bisexuality, an understanding of the role of multiple identifications in gender identity and object choice, and a reexamination of the triangular situation for girls. I focus on the life of Frida Kahlo—as revealed in biographies, journals, and art—to elucidate the layering of internal object choices. I conclude that object choice—heterosexual, homosexual, or bisexual—represents a composite or compromise formation.
 
Article
Changes in sexual orientation or object choice in midlife can represent many different dynamics. Understanding these involves recognition of the psychological developmental issues of this period, such as changes in self concept, identity, the awareness of time, and changes in expectations and goals, such as the wish to create a family. Other needs, for intimacy and emotional richness, or the revival of wishes for closer ties to one’s mother, can then become dominant and be expressed sexually. Earlier, more conventional choices can be abandoned, particularly after children are born. For some women an early homosexual relationship is replaced temporarily or permanently by a heterosexual one. This can represent permission to move outside the world ofwomen, or a wish for a family and children. Fluidity of choice may be more characteristic for women than men and may be related to characteristics of the female body.
 
Article
A model of group psychotherapy for persons with chronic mental illness is organized to provide members with some autonomy regarding treatment dosage and to address, within the group, problematic social relationships. Within this system, the therapist’s application of self-psychological theory attends to members’ efforts to change and grow (forward strivings) rather than to their repetition of prior traumatic relationships (expectations). Examples from established groups illustrate the therapist’s attending to patients’ strivings and “testing” to see if patients’ cautious efforts to try new experiences are acknowledged and appreciated and, if so, whether there also is evidence of forward movement.
 
Article
In this essay, the core concepts of psychoanalysis are set forth as the context for the application of classical psychoanalytic theory to the practice of couple therapy. Infantile sexuality and aggression are shown to have a powerful role in the interpersonal lives of family members. The repetition compulsion structures marital interaction and intergenerational dynamics. The intrapsychic emphasis of classical ego-psychology is viewed in the interpersonal arena, and the author suggests adding to the Oedipus and Narcissus myths a myth that resonates with this shift in emphasis. In introducing the “Pygmalion–Galatea process,” the author captures the universal attempt to change the psychic dynamics of the other or others. This ultimately mutual process begins with the infant’s mirroring of its caretakers—which includes language acquisition. Much of human interaction is fueled by subsequent attempts to create others in our own images of them and by their reactive compliance or resistance to that dynamic. Three case illustrations are presented to show how these phenomena manifest themselves in marital interaction and in dreams.
 
Top-cited authors
L. Alan Sroufe
  • University of Minnesota Twin Cities
Peter Fonagy
  • University College London
Karlen Lyons-Ruth
  • Harvard Medical School
Mary Target
  • University College London
Wilma Bucci
  • Adelphi University