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The Anatomy of a Symptom: Concept Development and Symptom Formation in a Four-Year-Old Boy
Abstract
The case of a four-year-old boy with a postural symptom that resolved rapidly in the course of play therapy is presented. Various unconscious fantasies appeared to underlie the symptom. In particular, this case illustrates a young child's sophisticated capacity to abstract a complex relational feature from a set of unconscious fantasies that then became the basis of his symptom. The structure of the boy's symptom is relevant to (1) the question of what constitutes a symptom, (2) the relationship between concept development and symptom formation, and (3) the status of certain primary process mechanisms as they relate to concept development. Proposals are presented to help situate the contributions of psychoanalytic theory with respect to the domain of cognitive psychology, and to illustrate the unique contributions of each domain toward their mutual enrichment.
... Elsewhere I have argued (Erreich 2007) that psychoanalytic researchers and practitioners have demonstrated that preverbal memory exists for both cumulative and discrete trauma, that such memories can be represented symbolically in bodily sensations and behavior in later childhood and adulthood, and that when expressive language develops it too can be recruited to represent these autobiographical experiences. ...
Psychoanalytic understanding depends on interpretations of evidence from speech and behaviors within clinical encounters. A clinician’s particular theoretical perspective orients them to favor one interpretation over another. Yet, this continuous processing of evidence often proceeds without a careful examination of the underlying basic concept: the representation being interpreted. This essay is an application of Charles Sanders Peirce’s theory of semiosis, which articulates types of representation and their implications for interpretation. A more nuanced understanding of aspects of representation and their use for specific purposes could generate greater consensus in psychoanalytic interpretations and their uses for clinical diagnosis or treatment—as Freud originally envisioned but lacked a semiotic theory to describe.
Di fatto, oggi sono in voga delle teorie che collegano la psicopatologia grave dell'adulto all'incapacità del bambino nella fase preverbale di formulare o rappresentare le esperienze traumatiche. A questo proposito, vengono analizzati i lavori di Howard B. Levine e Donnel B. Stern, partendo dall'idea che i risultati delle ricerche empiriche siano decisamente rilevanti per la teorizzazione psicoanalitica. Da questi risultati emergono scarse evidenze a supporto dell'ipotesi di un neonato con stati mentali "primitivi e non rappresentati". Di fatto, i risultati delle ricerche suggeriscono proprio il contrario: l'idea di un "neonato competente", dotato di una capacità di discrimina-zione percettiva estremamente accurata e di una capacità innata di registrare e rappresentare l'esperienza soggettiva, a livello di memoria sia procedurale sia dichiarativa, persino nel periodo prenatale. Non sembra quindi plausibile sostenere che i deficit di rappresentazione siano il nucleo della psicopatologia grave nell'adulto, la quale invece è il frutto di manovre difensive nei confronti di verità inconoscibili e indicibili e non dell'assenza di una capacità rappresentativa preverbale. Le ricerche pongono un'importante sfida alle teorie psicoanalitiche che postulano cosiddetti "stati mentali primitivi", esperienze "non formulate", "non rappresentate", "non simbolizzate" o stati "non-consci".
The author cites the prominence of theories that locate serious adult psychopathology in the preverbal infant’s inability to formulate or represent traumatic experience. The work of two such authors, H. Levine and D. B. Stern, is briefly considered. The frame of reference for this investigation is that clinical and academic research findings are highly relevant to psychoanalytic theorizing. It is argued that when such findings are considered, a view of the infant with “primordial and unrepresented” states of mind has little evidence to support it. In fact, research findings summarized herein point to an opposite view: that of the “competent infant,” one with highly accurate perceptual discrimination capacities and an innate ability to register and represent subjective experience in both procedural and declarative memory, even prenatally. Given the infant’s competencies, it seems implausible to hold that representational deficits are at the heart of serious adult psychopathology, which is instead seen to be the result of defensive maneuvers against unknowable and unspeakable truth rather than the absence of a preverbal representational capacity. Current research findings seem to pose a significant challenge for psychoanalytic theories that espouse “primitive mental states”; “unrepresented,” “unformulated,” or “unsymbolized” experience; or “nonconscious” states.
There is a great deal of disagreement about the definition and therapeutic value of an analytic process (AP). Does it exist? If it does, how to determine its presence, how to measure it, and in what kinds of treatments does it occur? In this article I highlight some of the literature from the “classical” school (such as by members of a COPE Study Group from the American Psychoanalytic Association (Committee on Psychoanalytic Education)), as well as from Theodore Jacobs, whom I consider to be an intermediate figure, and members of the “relational/interpersonal” school: Philip Bromberg, Edgar Levenson, and Donnel Stern. This selective review reveals three broad conceptualizations of the AP. It occurs (1) within the patient and is understood by the analyst via the patient’s words; (2) within the patient as revealed to the analyst both by the patient’s words and actions as well as by the analyst’s understanding of his or her own subjective experience in response to the analysand; and (3) as a result of the real interaction between patient and analyst, and not as a result of the vicissitudes of the patient’s transferences. All of these conceptualizations maintain that the AP can only be observed in the flow of what occurs between analysand and analyst over a period of time. Some empirical measures, which assess the presence or absence of an AP are noted. Yet, they are not generally employed in theoretical or clinical discussions, including supervision. Four decades ago, Brian Bird noted that “conclusions [about the analytic process] stem more often from assertions than from evidence and reasonable inferences.” This article emphasizes that analysts need to integrate systematic empirical studies with clinical approaches.
This paper is the third in a series of investigations into (1) the nature and development of unconscious fantasy, (2) its place in a contemporary model of mind that, parenthetically, suggests a possible solution to the problem of theoretical pluralism, and (3) its mode of operation in the mind. The aim of these investigations is to update the notion of unconscious fantasy, an indispensable construct in psychoanalytic theories that assume out-of-awareness mentation, and to situate that construct within contemporary views of mental functioning in disciplines such as philosophy of mind, cognitive science, and developmental psychology. At the same time, data accessible only through psychoanalytic work challenge these fields with findings that indicate the need for further investigation. This paper argues that experimental evidence on the phenomenon of “priming” lends support to one of the seminal claims in our field, one frequently attacked as an outmoded shibboleth: that is, that the past matters, whether encoded in declarative or in procedural memory. In common parlance, we are “primed” to respond to some situations in predetermined ways; the past primes us to experience the present in often unique and personal ways. There is evidence too that the priming mechanism and the encoding of subjective experience in declarative and procedural memory operate from very early in life.
Typical consult question “Please evaluate and treat this twenty-five year old pregnant female with a history of depression, currently in the second trimester of an unplanned pregnancy, who stopped her antidepressant medication at the time of a positive pregnancy test.” Depression is a significant public health problem that disproportionately affects women, often during the childbearing years. Perinatal depression, which refers to depression during both pregnancy and the post-partum period, is common, particularly in low-income and ethnic minority populations. It is associated with adverse consequences for the mother, infant, and other family members and often goes undetected and untreated. Depression during the perinatal period is associated with assessment and treatment challenges requiring unique collaboration between patient and maternal and child health and mental healthcare providers. Background Epidemiology of depression during pregnancy and the post-partum period Although many women and their providers still believe that pregnancy “protects” women from experiencing depression, research studies show that it is widespread. In the obstetric clinic setting, nearly 40% of women are identified with a mental health disorder, most commonly depression. The prevalence of antenatal depression in the community is approximately 10%, but may be as high as 27.6% among women in poor urban communities. Post-partum depression is also common, with around 13% of women meeting criteria for major or minor depression.
Typical consult question “Please see this thirty-two year old male coroner with many baseless somatic complaints of chest pain, shortness of breath, back pain, and difficulty urinating without catheterization, who requires a bowel regimen for defecation and has bone pain in the joints of both legs.” Background Medically unexplained symptoms (MUSs) have been estimated at about 10%. Estimates are that 27% of patients present to outpatient clinics with unexplained conditions. These conditions are seen frequently by the various medical specialties, including chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity, non-cardiac chest pain, and non-epileptiform seizures (NESs). Recent proposals made to change classification of somatoform disorders include the following: i. Relocating hypochondriasis, disease phobia, persistent somatization, conversion symptoms, illness denial, demoralization, and irritability to factors influencing medical illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM) V. ii. Placing hypochondriasis (renamed “health anxiety disorder”) and body dysmorphic disorder with the anxiety disorders. iii. Somatization disorder would be considered a combination of Axis II personality disorder and Axis I mood or anxiety disorder. Pain disorder and other somatic symptoms and syndromes would be placed under Axis III. iv. Reclassifying hypochondriasis under anxiety disorders along a spectrum of obsessive-compulsive disorders. v. Reclassifying conversion disorder as a dissociative disorder in DSM V, as in the International Statistical Classification of Diseases and Health-Related Problems, 10th revision (ICD-10). To support the re-classification, one group cites the high correlations between conversion symptoms and dissociative symptoms and shared features such as the role of trauma and similar underlying psychodynamics.
Philosophers of mind and cognitive psychologists have proposed that "mind" consists of myriad mental representations, namely, conscious and unconscious representations of belief/desire intentions. It is argued here that unconscious fantasies constitute a subset of the domain of mental representations, those concerned with conflicting wishes, affects, and defensive maneuvers. This proposal anchors the unconscious fantasy construct in a model of mind that accords with contemporary academic views in cognitive and developmental psychology and philosophy of mind, thus allowing psychoanalysts to enter into dialogue with those disciplines. Given this formulation, unconscious fantasy might well serve as a theoretical construct that applies to a large group of theories that share certain criteria regarding mentation. An analyst would then be at liberty to commingle insights from a menu of different theories without committing metatheoretical malpractice, resulting in a principled version of theoretical pluralism. Published case material from Kleinian, close process monitoring, and self psychological perspectives demonstrates how this redefined unconscious fantasy construct can encompass two major types of interventions that analysts make: content and process interpretations.
© 2015 by the American Psychoanalytic Association.
Psychoanalytic Single Case Studies of Children and Adolescents: Characterisation with the "Inventory of Basic Information in Single Cases" Right from its beginning single case studies on children and adolescents have been an highly esteemed means of communication in psychoanalysis; from the view of treatment research time and again critical arguments are brought forward. As single case studies may provide relevant answers for detailed process aspects, in this study we present a methodology for systematizing the reporting culture.
Right from its beginning single case studies on children and adolescents have been an highly esteemed means of communication in psychoanalysis; from the view of treatment research time and again critical arguments are brought forward. As single case studies may provide relevant answers for detailed process aspects, in this study we present a methodology for systematizing the reporting culture.
Reviews the book,
From classical to contemporary psychoanalysis: A critique and integration by Morris N. Eagle (see record
2010-09133-000). The entire contents of the current volume is conceptually organized, a veritable tour de force in its capacity to grab hold of a mass of sprawling, unruly theories, clinical data, and related research, and shape them into an easily digestible, overarching view of the current state of psychoanalysis. The book is divided between Freud’s theories and selected contemporary theories, and each of those two major sections consists of subsections on the nature of mind, object relations, psychopathology, and treatment, as seen from both the Freudian and the contemporary perspective. The third and last section of the book presents divergences and convergences between both camps, and among theories within each camp. It is hard to imagine any course taught in a psychoanalytic institute of any persuasion that would not derive immense benefit from the inclusion of related readings from this book. Most apparent in this volume is the clarity of Eagle’s thought and the deeply respectful attitude he brings to others’ work, even those he disagrees with. Eagle provides a cogent rationale for even the most arcane of Freud’s speculations regarding the functioning of the mental apparatus, including some unique insights such as the “ironic centrality of object relations” in that model. With equal clarity he lays out the contemporary critique of Freud’s work, especially his model of mind, a critique which proposes to substitute notions of experience as unformulated and indeterminate (e.g., Donnell Stern), the unconscious as consisting of veridical representations of early interactions (e.g., attachment theorists, Daniel Stern, Beebee and Lachman), and the mind as socially constructed (e.g., Stolorow, Mitchell). As these contemporary theorists have critiqued Freud’s model, Eagle provides an incisive critique of these newer models. However, I suspect that even the strict constructionists in each theoretical camp will appreciate Eagle’s efforts to present their theory in its best and most reasonable light. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Play therapy is a treatment modality in which the therapist engages in play with the child. Its use has been documented in a variety of settings and with a variety of diagnoses. Treating within the context of play brings the therapist and the therapy to the level of the child. By way of an introduction to this approach, a case is presented of a six-year-old boy with oppositional defiant disorder. The presentation focuses on the events and interactions of a typical session with an established patient. The primary issues of the session are aggression, self worth, and self efficacy. These themes manifest themselves through the content of the child's play and narration of his actions. The therapist then reflects these back to the child while gently encouraging the child toward more positive play. Though the example is one of nondirective play therapy, a wide range of variation exists under the heading of play therapy.
Psychoanalysis today is largely a psychology of consciousness: Post- and neo-Freudians form a marginalized community within North America in comparison to contemporary relational and intersubjective theorists, who emphasize the phenomenology of lived conscious experience, dyadic attachments, affective attunement, social construction, and mutual recognition over the role of insight and interpretation. Despite the rich historical terrain of theoretical variation and advance, many contemporary approaches have displaced the primacy of the unconscious. Notwithstanding the theoretical hairsplitting that historically occurs across the psychoanalytic domain, one is beginning to see with increasing force and clarity what S. Mitchell and L. Aron (1999) referred to as the emergence of a new tradition, namely, relational psychoanalysis. Having its edifice in early object relations theory, the British middle school and American interpersonal traditions, and self psychology, relationality is billed as "a distinctly new tradition" (Mitchell & Aron, 1999, p. x). What is being labeled as the American middle group of psychoanalysis (C. Spezzano, 1997), relational and intersubjective theory have taken center stage. It may be argued, however, that contemporary relational and intersubjective perspectives have failed to be properly critiqued from within their own school of discourse. The scope of this article is largely preoccupied with tracing (a) the philosophical underpinnings of contemporary relational theory, (b) its theoretical relation to traditional psychoanalytic thought, (c) clinical implications for therapeutic practice, and (d) its intersection with points of consilience that emerge from these traditions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
To examine the hypothesis that young infants ignore differences between lights and sounds and instead respond to auditory and visual stimuli as more or less similar depending on their intensity, a cardiac habituation/dishabituation method with a test for stimulus generalization was employed. In 2 experiments, a total of 40 3-wk-old Ss were repeatedly presented with white-light followed by white-noise stimuli of different intensities. A U-shaped relationship between magnitude of cardiac response (CR) and loudness was found. In view of previous findings that without prior visual stimulation a monotonic increase in CR to the same range of auditory stimuli results, this finding of a significant quadratic relationship with loudness suggests that Ss were responding to the auditory stimuli in terms of their similarity to the previously presented visual stimulus. A separate group of 14 infants presented with a more intense visual stimulus exhibited a shift in the intensity at which a minimal CR occurred. Results of a study with 31 adults did not show any systematic relationship between CR and loudness, indicating that unlike infants, adults do not spontaneously make cross-modal matches of intensity. (28 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The authors report on two experiments designed to test an important feature of the primary process: unconscious categorisation by attributes rather than by relations. These experiments were designed to provide support, independently of the clinical situation, for the presupposition of a psychological unconscious and for the presupposition that unconscious mentation is organised along primary-process lines. Their results were encouraging. They found that (1) unconscious similarity judgements could be made; and (2) these judgements were based on attributes (a primary-process mechanism) rather than relationships (a secondary-process mechanism). This independent evidence, obtained in controlled experimental studies supporting two fundamental psychoanalytic presuppositions, should be welcome news to psychoanalysts, given the continuing criticism from many quarters that basic psychoanalytic ideas lack independent validation. This paper begins with an overview of the primary processes with a special focus on the role of categorisation by attribute, the particular aspect of primary process explored in this study. Next a brief history of previous empirical investigations of primary process is given, following which the current experiments are presented.
Earlier work has provided experimental evidence for the existence of the primary and secondary process mental organization posited by Freud and has demonstrated that primary process effects are the more active unconsciously (Brakel et al. 2000). Primary and secondary processes were assessed by a categorization test in which qualitatively different principles could be used. In new experiments using the same stimuli, another significant implication of Freud's model was tested: that primary process mental organization has developmental priority. In these experiments, which studied 559 participants ranging in age from 3 to 80, it was found (1) that primary process mentation predominates in preschoolers; (2) that it is not until around age 7 that primary process organization is supplanted by secondary process organization; and (3) that after age 7 the predominance of secondary process organization remains remarkably stable throughout the life span.
No evidence for an assumption of a theory can be gained by data derived from methods dependent on that theory. Three experiments, using methods independent of psychoanalysis, test the psychoanalytic posit that primary process exists as a formal mental mode distinct from secondary process. The three experiments, using a nonpsychoanalytic index for primary process, test for a preponderance of primary process organization in three areas in which Freud observed primary process: (1) in unconscious mental states and during implicit tasks; (2) in the mental productions of preschool children; and (3) in anxiety states, as these are typically associated with unconscious conflict. All three experiments show significant results in favor of the primary process. Further, the three experiments taken together, because they account for seemingly disparate data, lend further credence to the original assumption. These positive results suggest that primary process may be more important than even Freud suspected. Perhaps it is the basic mental organization in many nonhuman mammals and some birds. Primary process organization may also underlie aspects of such basic psychological operations as generalizations in conditioning and assessments-in-action, as opposed to judgments proper, about how one would act. Finally, primary process may play a key role in drive activity. Three types of experiments are proposed to test these far-reaching applications of the primary process concept.
In earlier publications, experimental evidence was provided for the existence of the primary vs. secondary process mental organization posited by Freud. A well-established cognitive categorization test based on attributional and relational similarity was found to map on to primary and secondary principles of mental organization respectively, thus offering the opportunity to test hypotheses drawn from psychoanalytic theory independent of the clinical situation. In prior work, primary process shifts occurred under three different conditions--all predicted by psychoanalytic theory: (1) when stimuli were (subliminal) unconscious; (2) when participants were 3-5 years of age; and (3) when tasks were implicit. In the current study, a fourth condition is examined dealing with the relationship of conscious anxiety to primary and secondary processes. In a naturalistic study, 120 patients waiting in medical center waiting rooms rated how anxious they felt on a 10-point scale and then completed a version of the categorization test alluded to above. Those who reported any anxiety at all showed a significant shift toward primary process categorization over those participants who rated themselves as calm. The implications of this fourth finding are discussed with respect to signal anxiety and symptom formation.
This study synthesizes current information from the various fields of cognitive science in support of a new and exciting theory of mind. Most psychologists study horizontal processes like memory and information flow; Fodor postulates a vertical and modular psychological organization underlying biologically coherent behaviors. This view of mental architecture is consistent with the historical tradition of faculty psychology while integrating a computational approach to mental processes. One of the most notable aspects of Fodor's work is that it articulates features not only of speculative cognitive architectures but also of current research in artificial intelligence.
Bradford Books imprint
Similarity and analogy are fundamental in human cognition. They are crucial for recognition and classification, and have been associated with scientific discovery and creativity. Successful learning is generally less dependent on the memorization of isolated facts and abstract rules than it is on the ability to identify relevant bodies of knowledge already stored as the starting point for new learning. Similarity and analogy play an important role in this process - a role that in recent years has received much attention from cognitive scientists. Any adequate understanding of similarity and analogy requires the integration of theory and data from diverse domains. This interdisciplinary volume explores current developments in research and theory from psychological, computational, and educational perspectives, and considers their implications for learning and instruction. Well-known cognitive scientists examine the psychological processes involved in reasoning by similarity and analogy, the computational problems encountered in simulating analogical processing in problem solving, and the conditions promoting the application of analogical reasoning in everyday situations.
Several aspects of developmental change that are dependent on interactions between parent and infant are examined for their value in casting light on the processes of change in adult psychotherapies. First, the domain of implicit knowledge (where changes necessarily occur in nonverbal infants) is identified. The vast majority of therapeutic change is found to occur in this domain. We then examine the improvised, largely unpredictable, nonlinear movements toward mutual goals that characterize the processes of parent–infant and therapist–patient interactions. Finally, we provide a microdescription of these processes and provide a terminology for the “moments” that make up their flow. Of particular importance is the “moment of meeting,” in which the participants interact in a way that creates a new implicit, intersubjective understanding of their relationship and permits a new “way-of-being-with-the-other.” We view “moments of meeting” as the key element in bringing about change in implicit knowledge, just as interpretations are thought to be the key element in bringing about change in explicit knowledge. © 1998 Michigan Association for Infant Mental Health
This essay locates writing and literary experience on a spectrum of human activities that engage not only language and text, but also unconscious fantasies of the body. It explores possible contexts in psychoanalytic and literary theory for understanding a reader's experience of textuality in relation to experiences and fantasies of the infantile body. Using Freud's own dream analyses and his work with hysteria, in relation to the theory of infantile sexuality, the essay examines the fluid interchanges between subject and object, text and body that form part of both analytic and literary experience. To illustrate more fully the intersection between psychoanalytic and literary experience, the essay concludes with some thoughts as to the place of the body in the diaries of Alice James and in the late fiction of her novelist brother, Henry James.
Six experiments explored the hypothesis that the members of categories which are considered most prototypical are those with most attributes in common with other members of the category and least attributes in common with other categories. In probabilistic terms, the hypothesis is that prototypicality is a function of the total cue validity of the attributes of items. In Experiments 1 and 3, subjects listed attributes for members of semantic categories which had been previously rated for degree of prototypicality. High positive correlations were obtained between those ratings and the extent of distribution of an item's attributes among the other items of the category. In Experiments 2 and 4, subjects listed superordinates of category members and listed attributes of members of contrasting categories. Negative correlations were obtained between prototypicality and superordinates other than the category in question and between prototypicality and an item's possession of attributes possessed by members of contrasting categories. Experiments 5 and 6 used artificial categories and showed that family resemblance within categories and lack of overlap of elements with contrasting categories were correlated with ease of learning, reaction time in identifying an item after learning, and rating of prototypicality of an item. It is argued that family resemblance offers an alternative to criterial features in defining categories.
Normal human adults judge two identical objects to have the same shape even when they are perceived through different modalities, such as touch and vision. The ontogenesis of man's capacity to recognise such intermodal matches has long been debated. One hypothesis is that humans begin life with independent sense modalities and that simultaneous tactual and visual exploration of shapes is needed to learn to correlate the separate tactual and visual sense impressions of them1-3. A second hypothesis is that the detection of shape invariants across different modalities is a fundamental characteristic of man's perceptual-cognitive system, available without the need for learned correlations4-7. Recent research has shown that 6-12-month-old infants can recognise certain tactual-visual matches8-11. However, such data cannot help resolve the classic theoretical debate. Infants of this age repeatedly reach out and touch objects they see, and such simultaneous bimodal exploration presumably offers ample opportunity for learning to correlate tactual and visual sense impressions. The experiments reported here show that humans can recognise intermodal matches without the benefit of months of experience in simultaneous tactual-visual exploration. We demonstrate that 29-day-old infants can recognise which of two visually perceived shapes matches one they previously explored tactually, thus supporting the second hypothesis listed above.
4 locative categories were investigated to determine whether their examples were organized according to the prototype/nonprototype distinction. A ranking task was presented to 30 adult subjects to see whether they would judge those instances which had been designated as prototypes by the experimenter to be the best exemplars of each category. An elicited-drawing task was administered to see whether there was a preference for drawing adult-designated prototypical instances. A matching task was presented to determine whether fewer errors would occur in response to adult-designated prototypical instances. The latter 2 tasks were presented to 4-year-olds, 6-year-olds, and adults, with 17 subjects in each group. The results provide strong evidence of prototype/nonprototype organization in 3 of the locative categories and weak evidence in the fourth. Tentative conclusions regarding the development of such organization are drawn.
Evidence is put forth to support the previously presented view (Brenner 1994, 1998) that present knowledge of mental conflict and compromise formation renders invalid the widely accepted theory of mind as functionally separable structures called id, ego, and superego. The nature, origins, and timing of conflict and compromise formation in mental development are discussed, as well as their relation to psychic trauma.
The author argues that unconscious fantasy, properly defined, necessarily represents the three-dimensional intersection of wishful thinking (fantasy), veridical perception of the environment (reality), and the naive cognition of childhood. It is proposed that, although attachment theory developed out of the intent to capture the unalloyed reality of dyadic experience, that experience is inextricably entangled with the other two components, wishes and naive cognition, and furthermore, that the behavior of children in the attachment paradigm can only be accounted for by positing the existence of underlying unconscious fantasies. In making these arguments, the author also addresses the development of unconscious fantasies and their relationship to compromise formations and trauma.
The author describes a study that investigated what three- and four-year-old girls and boys know about the link between genital difference and gender difference by asking them to construct both a girl doll and a boy doll, using any of an assortment of anatomical features, including both male and female genitals. The results were interpreted as supporting the assumption of a normal early developmental period of psychological bisexuality; as contradicting the theory that when genital difference is discovered, girls are more distressed than boys about their genitals; and as evidence that both girls and boys envy the genital of the opposite sex.
Free association is therapeutically helpful in the regulation of states of consciousness. A person who free-associates enters a particular state of consciousness characterized by increased subjective self-awareness and disregard for reality, together with implicit pulls for objective self-awareness and reality adherence. Free association facilitates the patient's learning to integrate and to shift flexibly among points on these dimensions. Tensions existing in the free-associative state are embedded in a similar tension between free associating and reacting to the analyst's interventions, so interplay between free association and intervention also facilitates regulation of states of consciousness.
The concept of unconscious fantasy should be retained as fundamental to any psychoanalytic approach. The concept is reexamined in the face of two challenges: today's theoretical pluralism and the recent integration of findings from academic research. The first section reviews post-Freudian theoretical contributions to Freud's original concept, concluding that in its evolved form it is flexible enough to serve multiple perspectives. The second section examines four features identified with primary process thinking, demonstrating that a model of early mentation based on adult dream work cannot be supported by research on early development. However, the contemporary concept of unconscious fantasy is compatible with research findings from child development studies and cognitive neuroscience, permitting psychoanalysts to enter dialogue with those fields. Our contribution is not the posit of a new form of thinking (primary process) but an understanding of how general cognitive processes are enlisted for motivated purposes.
Primary and secondary process mentation: Their role in mental organization
- A Erreich