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The Texture of Treatment: On the Matter of Psychoanalytic Technique
Abstract
In simple, jargon-free language, Herbert Schlesinger sets out to demystify technique, to show how it is based on basic principles that are applicable both to psychoanalysis and to the psychotherapies that derive from it. He has little need for conventional theory; rather, he reframes essential analytic notions - transference, resistance, interpretation, regression, empathy - as processes and assigns technique the goal of promoting the patient’s activity within the treatment situation. The aim of the analytic therapist is to restore to the patient active control of his own life.
... However, to our best knowledge no previous study has examined the relationship between client resistance and attachment with the therapist in terms of real aspects of the therapeutic relationship (Gullo et al. 2012), especially from the viewpoint of the therapist (Mallinckrodt and Jeong 2015). This existing gap in the literature is even more profound, given that resistance in psychotherapy is not a static condition, but rather a dynamic process (Schlesinger 2003). ...
... Yet, further research is needed on their role on the broader therapist-client interactions. For example, therapist's neutrality and limits are in the crux of the psychoanalytic approach (Schlesinger 2003), which may explain somehow our results. However, trait-like predispositions that urge someone to receive psychoanalytic therapy as a treatment of choice may be another plausible explanation that warrants empirical evidence. ...
... As the aforementioned findings depict, resistance in the psychotherapeutic process is a dynamic process (Schlesinger 2003). The results of the present study consort with the literature which supports that many resistance manifestations make their appearance around the vacations period in psychotherapy, e.g. ...
Through the lens of contemporary views on client resistance and attachment theory, which underpins the role of security in psychotherapy, the present study examines the relation between client resistance and client attachment to therapist. Forty-six clients and 19 therapists in long-term psychotherapy completed the Client Attachment to Therapist Scale and a therapist-reported questionnaire for client resistance, respectively, in three different times including the therapist’s summer holidays, so as to take into consideration the role of the therapist’s temporary absence as a real relationship component. Results indicate that resistance is negatively associated with clients’ secure attachment to their therapists, while it is positively associated with insecure attachment patterns. Also, holidays in psychotherapy were found to intervene in the interrelation between client’s resistive behaviors and attachment security. These preliminary findings indicate the interpersonal and statelike character of client resistance, a conceptual shift that augments clinical work as clients and their resistances are seen in more benevolent terms.
... To the degree that transference of defense (Gray, 1994) or of other aspects of mental structure (Sugarman, 2006) occurs, the primary objects become less central to the occurrence of transference. Many analysts today see transference as ubiquitous and involving more than displaced or projected object ties (Joseph, 1985;Schlesinger, 2003). ...
... Freud, 1936;Gill, 1982;Gray, 1994) can be expanded to the transference of intrapsychic structure more generally (Sugarman, 2003a(Sugarman, , 2003b(Sugarman, , 2006 so that transference can be more comprehensively understood as the interpersonalization of psychic structure (Silk, 2004). Joseph (1985) seems to have a similar idea in mind with her emphasis on the total situation of transference as does Schlesinger (2003) with his view of transference as a process. Thus, a transference neurosis has occurred when the child's (or adult's) internal structure including impulses, defenses, prohibitions, ideals, etc. become centered on the person of the analyst and ⁄ or in the analytic interaction much of the time and with significant emotional intensity. ...
Child analysis continues to be seen as a different technique from adult analysis because children are still involved in a developmental process and because the primary objects continue to play active roles in their lives. This paper argues that this is a false dichotomy. An extended vignette of the analysis of a latency-aged girl is used to demonstrate that the psychoanalytic process that develops in child analysis is structurally the same as that in adult analysis. Both revolve around the analysis of resistance and transference and use both to promote knowledge of the patient's mind at work. And both techniques formulate interventions based on the analyst's appraisal of the patient's mental organization. It is hoped that stressing the essential commonality of both techniques will promote the development of an overarching theory of psychoanalytic technique.
... Here, in internal fantasy regarding this primal theft, is the analyst's dilemma: "How can I take pleasure in this work if I find you, my patient, of such interest to me, so involving and so fascinating, and if I get so much myself from it, when you are in pain?" Regularly experiencing the painfulness of the work may reflect an analyst's guilt at its intensely absorbing, involving, and pleasurable, aspects, the affective price he pays for the privileges of his vocation, as if it were in fact "sadistic." When Schlesinger (2003) wrote that his very intention to discuss the pleasures of psychoanalytic work was "inviting misunderstanding on a grand scale" (p. 186), he was likely alluding to analysts' difficulties with conscious pleasure in the work: a pleasure that could mistakenly be regarded as of its very nature violative and exploitative, pleasure taken. ...
Analysts have often described their work as depriving, painful, and hard to endure, while its pleasures have been the subject of little commentary. The real history and ongoing temptations of boundary violation long ago made the gratifications of psychoanalytic work a matter of anxiety. Analysts’ pleasure in their work was problematized. Some of this problematizing is necessary because of real risk, but much of it is not only unnecessary but misleading and destructive. Psychoanalysts pursue achievement of a unique form of human intimacy, yet acquired habits of professional modesty and humility have encouraged the illusion that analyzing can occur without desire or ambition on the analyst’s part. These habits have made it difficult for analysts to openly discuss what they get from the intimacy of analyzing that yields its pleasures. Our field demands that analysts deny that the work provides much more than pain (at least until the conclusion of an analysis), but psychoanalysis both misunderstands and misrepresents itself if we cannot speak of the distinctly broad range of pleasures available in analyzing.
... In psicoanalisi ogni cambiamento implica diversi livelli di esplorazione e comprensione, che comprendono le modalità relazionali del paziente, dove queste dinamiche conflittuali hanno trovato una sintesi in un particolare stile di personalità (Shapiro, 1965). Tali modalità relazionali, poiché si sono sviluppate a scopo di adattamento, resistono al cambiamento (Schlesinger, 2010). Importante, nel setting analitico, non è solo comprendere le modalità relazionali del paziente -e questo è cruciale -ma anche le fantasie nucleari che cercano espressione e le relative paure evocate, le quali stanno alla base, e danno forma, alle modalità relazionali del paziente. ...
... Psychoanalysis entails multiple levels of exploration that include understanding the patient s mode of relating and how these forces of conflict have been synthesized into personality styles (Shapiro, 1965). Insofar as these modes of relating have been developed in the service of adaptation they resist change (Schlesinger, 2010). Of importance in the analytic setting is not only an understanding of the analysand s modes of relating, and this is crucial, but also the core fantasies that seek expression and the attendant fears that they elicit, which together underlie and give shape to the analysand s mode of relating. ...
Subjectivity and intersubjectivity, like countertransference, are terms that now cut across theoretical paradigms. This article explores intersubjectivity from the perspective of modern conflict theory and makes the case that there is much in common between Brenner’s (1982, 1986, 2006) and Arlow’s (1979, 2002) ideas about how the analyst’s mind works and our current discussions about subjectivity and intersubjectivity. Where the concept of intersubjectivity becomes polemical is when we draw implications regarding the claims the analyst can make about ever knowing the analysand’s mind as a separate entity from his or her own.
... What we lose in that option is what Freud wanted to add in this paper, which is a reminder that, besides being a name for a common obstacle, "the resistance" also names a highly individual motivation (something fed by an individual's personal "impulses"). And in practice we can correct for the error by following the advice of Schlesinger (2013) to focus on ensuing associations and of Faimberg (1996) to "listen to the patient's listening." ...
There are two crucial passages in Freud's "Remembering, Repeating and Working Through" that require the analyst to think about entities in the mind while at the same time thinking about the mind as a continuum of activity. Although that is a challenging paradox, the passage that allows the analyst to find discrete memories in the patient's continuous behavior was easily absorbed into psychoanalytic custom. In the reverse direction, however, the description of the patient finding his way from the analyst's discrete interpretations to his own continuous experience of strain was most often pasted over with superfluous platitudes. A practical reason for this aversion is suggested.
Patients often ask questions to which they already know the answer. Despite their ubiquity, little is written about understanding or handling them. The following paper uses Speech Act Theory and the concept of “cosigning” to present a theoretical understanding of patients’ questions about the obvious along with three clinical vignettes to demonstrate their technical management. The unconscious intent behind such questions can be inferred by analyzing their effects on the analytic process, the analyst’s moment-to-moment countertransference, and the pressure they exert on the analytic relationship. The optimal response to cosigning questions depends on the particular dynamics which necessitate their use. For patients who can mentalize their behavior, direct interpretation or observation followed by interpretation can be used. For patients whose mentalization capacity is limited, consciously playing along with the questions can serve as a preamble to offering interpretations of the motives behind them.
Thabet , E. & Abdul Hamid, M., (2022 ). Objectives: Psychometric objective: Standardization of rationing of the Narcissistic Personality Questionnaire, developed by Medhat Abdel-Hameed Abdul Latif Ahmed Abu Zaid. Therapeutic & interventional Objectives: to detect the significance differences in Narcissistic Personality Disorder between the two groups (therapeutic and control) for post measurements & Verifying significance of Repeated Measurement Analysis, and measuring the effect size of the program. Method: The comparative descriptive inference method for the Psychometric properties of the study tool, and the semi-experimental method, with the design of the two semi-equal groups for interventional study. Participants: (n=16) Narcissistic personality disorder, Aged: (22-28), which divided into 2 groups (therapeutic & control), the strength of each (8), after fully multiple matched. Tools:1-Transference-Focused Analytical Group Psychotherapy Evaluation Inventory, developed by Medhat Abdel-Hameed Abdul Latif Ahmed Abu Zaid. 2- Transference-Focused Analytical Group Psychotherapy Program Protocol, developed by Medhat Abdel-Hameed Abdul Latif Ahmed Abu Zaid 3- Narcissistic Personality Questionnaire, developed by: Ethan H. Motter, translated by: Medhat Abdel-Hameed Abdul Latif Ahmed Abu Zaid. Measurement procedures: The scale was applied three times to the two groups (Pre, Post & Follow up) but the program was applied only to the therapeutic group, and the control group had only some unsystematic psychological support according to the code of ethics.. Statistical Techniques: Performed with SPSS-21 by: Medhat Abdul Hamid Abdul Latif Ahmed Abu Zeid,: Mathematical mean, standard deviation, Pearson correlation coefficient of raw values directly, alpha Cranach coefficient , percentile. Cut score. Medium test, Ch2, (U) Value for The Man Whitney Test, (Z) Value for Wilkson Test, Effect- Size Coefficient, Columgrove-Smirnoff Test & Significance of Repeated Measurement Analysis. Results: findings mirrored verification of the three hypotheses.
The author discusses a process of recommending returning to in-person analysis during the period from April to October 2021, after working by phone since March 2020. Clinical excerpts from several analytic cases are presented and discussed in terms suggested by that material and other sources. Previous work on interpretive authority and on the interpretation of verbal and nonverbal material, still generally relevant to the analytic situation, is discussed as a background for integrating more specific ideas particularly relevant to this phase of the COVID-19 pandemic, including preliminary concepts of revolution and resistance, danger and opportunity, and convenience and necessity.
Background:
Despite the increase in the number of clinical psychologists contributing to stroke care, the psychosocial aspects of rehabilitation will of necessity continue to be addressed by other rehabilitation professionals The clinical psychology of stroke rehabilitation is a growing field, with an extant literature reflecting different theoretical schools of psychotherapy. Psychoanalytic ideas have begun to enter the practice of neurorehabilitation, but with so far little written about stroke specifically.
Method:
In this commentary, I provide a brief overview of central themes in psychoanalytic theory, and link them to stroke rehabilitation using clinical vignettes.
Results & conclusion:
I argue that, by bearing strong feelings; attending to multiple communicative channels; considering transference and countertransference; and accepting more fully the pessimistic and despairing aspects of our patients' experiences, we can become more psychologically effective rehabilitation professionals.
The discussion of splitting within mental health treatment teams emerged from British object relations theory, a movement concerned with understanding the interplay between individuals in terms of their inner lives. Over time, the terminology used in this domain has become reified and splitting has been discussed in terms that are apt to frame the process as patient-precipitated. This is apt to encourage simplistic inferences, and attribute to patients responsibility for events that are beyond their control. In this article, the historical development of the psychoanalytic account of team splitting is examined and contemporary critiques are reviewed. It is suggested that the resultant one-person picture overlooks the ways that psychoanalytic theory has been subject to controversy and revision. In the last section of the article, I propose that relational innovations in psychoanalytic theory provide a way to rediscover the richness of early descriptions of splitting.
Between-session contact between patient and therapist is one of the key features of dialectical behavior therapy (DBT) and enhances generalization and learning of new behaviors and coping skills because it gives the therapist the opportunity to work with the patient “in vivo,” when they are most in need of using skills. This aspect of DBT is a reason why clinicians unfamiliar with the treatment believe it to be too burdensome for therapists and choose not to learn it. Clinicians who have not yet learned the treatment may think that DBT clinicians are on the phone with their patients continually. This is a misperception. In fact, clinicians who have learned DBT can find that they spend less but more effective time on the phone with their patients with borderline personality disorder because DBT provides specific guidelines for when and how to have contact with patients between sessions. These guidelines provide a structure for intersession contact that aims to help patients when they need it (e.g., to refrain from engaging in NSSI or making a suicide attempt) and does not involve endless time on the phone.
An intervention is something therapist communicates to a patient, either verbally or non-verbally. Three types of interventions in psychodynamic psychotherapy are basic, supporting and uncovering. It is important to remember that therapist also communicate with patients non-verbally. An increase in defensive behavior of any sort is usually an indication that intervention was too deep, poorly timed, incorrect or off the mark. Basic interventions are used in all psychodynamic psychotherapies. Trainees are usually intuitively aware that more impaired patients who have trouble organizing themselves need their therapists to provide structure, direction, and information. During the course of treatment, therapist impart all sorts of information to patients. In psychodynamic psychotherapy, silence is an intervention. Therapist makes a conscious choice to be silent in a variety of situations. Supplying interventions provide the most direct and immediate way to support weakened function. Modeling is an implicit way to show someone a new way to do something.
Setting the frame is essential to any type of psychotherapy, it establishes boundaries and sets up a safe relationship in which patient and therapist can work. The frame of psychotherapy includes: role, time, setting, money, contact information, what to do in the event of an emergency, confidentiality and issues relating to traineeship. A role is a part or function that we play in a particular situation. To set up a psychotherapeutic situation, we set aside a specific, consistent period of time during which our attention is focused exclusively on the patient. There are three major reasons why patients might need to contact the therapist outside of session time: emergencies, the need to cancel or reschedule a session and to request medication refills. A boundary is defined as the edge of appropriate behavior. Boundary "crossing" is a benign deviation from the frame that may advance the treatment and does not harm the patient.
This article explores the diminished role of the superego in contemporary psychoanalysis, and it focuses on Loewald’s perspective on the superego as original and as a possible way to rethink the meaning of the concept. Loewald saw the superego as representing the modality of the future; so, it beckons us forward and ought not be construed as merely critical. I also argue that Loewald’s perspective on the superego anticipates the emerging literatures on mentalization (especially mentalized affectivity) and autobiographical memory.
Clinical psychoanalysis has ignored shame as the source of psychopathology, despite a burgeoning literature. Here the authors present an analysis carried out with a hospitalized child diagnosed as borderline. The analyst's efforts to interpret the patient's self-concealing behaviors elicited intensified shame reactions not clearly understood at the time. Here the authors explore the evolutionary and developmental origins of shame as a primary affect modifying the interest the organism has in novel stimuli. The authors briefly explain why clinicians overlook the relationship of shame to both psychopathology and psychoanalytic technique. In this case, the illness, based largely on the child's chronic experience of humiliation, remitted in response to the supportive influence of an extraordinarily sensitive hospital setting combined with the analyst's growing willingness to accept the child's positive response to being accepted on his own grounds. These laid the foundation for a psychoanalytic process to take place. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
DECONSTRUCTING MENTALIZATIONCASE REPORTDISCUSSIONCONCLUSIONREFERENCES
Noting that the topic of sacrifice has remained largely unaddressed in psychoanalytic literature, the authors offer a discussion of it. Their elucidation of sacrifice opens with the definition and etymology of the word and moves on to the place of sacrifice in various religious traditions. They then summarize Freud's views on the topic and suggest that the subsequent analytic contributions have gone in three directions: the first extends and modifies Freud's proposal of triadic-hostile origins of sacrifice, the second locates such origins in dyadic and loving relations, and the third seeks to synthesize the foregoing trends. The authors then delineate the triad of altruism, masochism, and narcissism that underlie sacrifice. They propose that a spectrum of phenomena, ranging from healthy to pathological, is subsumed under the rubric of sacrifice. They also discuss the significance of such ideas to the conduct of psychotherapy and psychoanalysis.
2 MATCHED GROUPS OF ADOLESCENT MALE DELINQUENTS, INFORMALLY RECRUITED FROM STREET CORNERS, WERE DIFFERENTIALLY TREATED DURING THE COURSE OF 20 TAPE-RECORDED INTERVIEWS ON 4 CLASSES OF OPERANTS: HOSTILE AND POSITIVE STATEMENTS, PROMPT ARRIVAL AT WORK, AND GENERAL EMPLOYABILITY. HOSTILE STATEMENTS WERE FOLLOWED BY A MILD AVERSIVE CONSEQUENCE (I.E., DISAGREEMENT OR INATTENTION) WHILE THE OTHER SELECTED OPERANTS WERE FOLLOWED BY A POSITIVE CONSEQUENCE (I.E., VERBAL PRAISE OR A SMALL GIFT). RESULTS IN BOTH A LABORATORY AND A NATURAL SETTING SHOWED A SIGNIFICANT INCREASE IN THE FREQUENCY OF BEHAVIORS FOLLOWED BY POSITIVE CONSEQUENCES. ATTEMPTED PUNISHMENT OF HOSTILE STATEMENTS, HOWEVER, RESULTED IN NO SIGNIFICANT DECREASE. SOME CLINICAL IMPLICATIONS OF THE OPERANT PROCEDURE ARE DISCUSSED. (25 REF.)
For most analysts, the notion of a standard technique, a fixed canon of analytic procedure, has included "no touching" as an unwritten rule. Despite that everyone knows first-hand, or has heard, that occasionally this boundary has been crossed by wll-known analysts, rather than violated, and with useful therapeutic effect, the topic has received little attention in the literature and is ignored in the curricula of analytic institutes. We review the literature on psychoanalysis and psychotherapy to show that there is much clinical evidence and opinion that for certain age and illness groups the judicious use of nonerotic touching has been salutary. Institutes should consider including in their curricula such generally ignored topics as the role of nonerotic touching, the indications for medication and the complexities of working with victims of incest and other conditions of traumatic origin.
While character is an indispensable term in psychoanalytic discourse, it is not primarily a psychoanalytic term. The psychoanalytic theories of neurosis and development are built around the idea of the "complementary series." While psychoanalysis has powerful theories about the "accidental" complement, it only recognizes the "constitutional" complement, and psychoanalysis has nothing to say about it. Current research may shed more light on this latter component and also provide the data for future psychoanalytic theorizing about character and personality.
In much of psychoanalytic theory and therapy, Freud repeatedly inferred a causal connection between thematically kindred events by relying on the kinship between their thematic contents. This paper strongly endorses his search for causal explanations. But it argues in detail that (1) his causal inferences from thematic connections rest on an important fallacy, which undermines major etiologic conclusions in psychoanalysis; (2) a related, weighty inferential error is damaging to the Freudian theory of transference, when it infers the pathogenic role of an early childhood scenario from the thematic reenactment (recapitulation) of that scenario in the adult patient's interactions with the analyst, and with other people. Both arguments draw on subject matter in psychoanalysis, physics, evolutionary biology, common-sense psychology, history, and medicine to arrive at a fundamental caveat for all of the sciences: Even when the thematic kinship (or so-called "meaning connection") between events is indeed of very high degree, this fact itself does not license the inference of a causal linkage between these events. A corollary of this result is that we must reject the accusation of Karl Jaspers and the hermeneutic philosophers that Freud's own conception of the psychoanalytic enterprise suffered from a "scientistic self-misunderstanding."
This paper summarizes an ego psychology-object relations theory and its application to psychoanalytic technique, particularly to the analysis of the transference. The relative importance of verbal, nonverbal, and generally relational "channels" of communication in patients with differing degrees of transference regression is examined. The use of countertransference reactions in formulating transference interpretations is reviewed. The relations between unconscious meanings in the "here-and-now" and unconscious meanings in the "there-and-then" are explored in the transferences of patients with varying degrees of severity of psychopathology. Differences with other theoretical approaches are highlighted throughout.
The changes in psychic structure attributed to the effects of interpretation when they transpire during psychoanalysis occur spontaneously in the course of normal development. The parental behaviors associated with the changing structure of the normally developing personality are similar to various specific and nonspecific features called "supportive" in psychotherapy. These features include interventions that promote a "learning" state by optimizing anxiety, foster a sense of self and of agency, encourage mature relationships, and strengthen adaptive defenses.
Ordinary intellectual capacities can be used for defensive as well as adaptive purposes. The author focuses on how a particular aspect of the intellect--language skills--can serve defensive functions. Using clinical examples, he examines how the defense "mechanism" of isolation operates through the use of common verbal formulas, through the deletion or substitution of conjunctions, through vagueness and indefinite reference. Other expressions of isolation include shifting emphasis away from what is important, excessive generalizing, and the development of an elliptical private language. He concludes with a discussion of how clinicians can learn both to listen to the patient empathically and to recognize and work with these defensive operations.
The author argues that to consider the place of facts in psychoanalysis one must first of all distinguish between the use of the term fact in its everyday sense, in which its opposite would be untruth, from the scientific sense in which the term refers to a construction that has been awarded the status of fact by the theory in which it is embedded. Theories in sciences of human behaviour or experience must include not just the hierarchical arrangement of concepts and constructs of the physical sciences, but also the process orientation in which time is the major organising dimension. Facts, as constructs, have different significance in each of these versions of theory, and the meaning of validation, as well as the procedures for determining validity, also differ.
Although analytic process (AP) is a core concept in psychoanalytic theory and practice and has emerged as an important variable in outcome studies, there is no consensus regarding its definition and operationalisation. This paper describes the development and validation of the Columbia Analytic Process Scale (CAPS), a rating scale developed to evaluate the presence or absence of AP in a single psychoanalytic session transcript for purposes of an outcome study. Definitions of interrater reliability and construct validity are reviewed and two studies designed to evaluate these important aspects of the CAPS are presented. The results demonstrate that the CAPS has adequate interrater reliability (kappa = .5). To establish construct validity the plan was to compare the CAPS rating of AP to clinical consensus. However, when a group of ten senior training and supervising analysts at Columbia were asked to rate five psychoanalytic session transcripts, no clinical consensus could be established. Statistical analysis of the pattern of the analysts' clinical ratings showed that the largest portion of the variance was accounted for by the error term of a two-way ANOVA. The implication of this finding is that the construct of AP itself is ill-defined. The results of this study suggest that the commonly used term AP has less consensually held meanings than analysts tend to believe; the impact of lack of definition of key terms on clinical and research pursuits within psychoanalysis is discussed.