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A disturbance of interpreting, of symbolisation and of curiosity in the analyst-analysand relationship : (The patient without insight)
Abstract
The author examines the function of the analyst who may distort the unconscious communication with the patient by means of the expression of his countertransference. He studies a disturbance in curiosity and in symbolisation in a patient with a narcissistic pathology. Both problems were related to this failure in interpreting. The curiosity of the patient, which initially seemed to be non-existent, was found to be directed towards investigating the mind of the analyst, this being his sole purpose. The disturbance in symbolisation was manifested as a constant verbal acting out, which was expressed as verbal communication empty of meaning. A change in the interpretative attitude enabled a modification in the objective of the curiosity, which became focused on investigating his own inner world, and the emptiness of the verbal communication was replaced by representations. This change in communication allowed the analyst to relate the facts of the psychoanalytic relationship both with the patient's phantasy and with the events in his history. An idealised identification with destructive aspects of the mother towards the father was discovered. This idealisation had been sustained by the analyst by means of his errors in interpreting. The author explores disturbances in symbol formation and in the use of symbols, and he considers the different states of emptiness.
... When facing sudden, unexpected, and challenging life circumstances, this can also escalate sudden acute suicidality, with risk for lethal actions (Ronningstam, Weinberg, Goldblatt, Schechter, & Herbstman, 2018). Maldonado (2005) identified the manifestation as a constant verbal acting out in the alliance, that is, a verbal communication that is empty of meaning. This affects alliance building as it can evoke the therapist's intense negative reactions and countertransference. ...
... Difficulties separating the therapist as a person from her internalized experiences of and relationship to her mother readily evoked the impression that the patient was developing a negative transference reaction that calls for the therapist's transference-focused interpretation. However, using the concept of transitional space (Winnicott, 1971) concreteness can be a defense or a means to avoid the reexperience of intense affects or early developmental trauma (Cancelmo, 2009;Maldonado, 2005Maldonado, , 2006. In addition, alexithymia, which involves a deficit in symbolization of emotional somatic and mental states, can also contribute to concreteness, especially as it relates to an unawareness of or incapacity to distinguish physical and affect states, with a lack of words for emotions. ...
... In this phase, countertransference may not be a reliable source of information about the patient's internal processing. Maldonado (2005) points to the failure of interpreting and the risk for distorting or misinterpreting unconscious processes and acts based on countertransference, which can negatively impact curiosity and symbolization in patients with PN or NPD. ...
Pathological narcissism (PN) and narcissistic personality disorder (NPD) have primarily been identified by striking external features, such as superiority, attention seeking and a critical or condescending attitude, and less attention has been paid to the internal processing contributing to this particular personality functioning. High dropout from treatment and challenges in building a therapeutic alliance with these patients call for further understanding of the complexity of disordered narcissism. Recent research on neuropsychological underpinnings to narcissistic pathology have provided valuable information that can inform therapeutic interventions for patients with this personality pathology. Internal processing in patients with PN or NPD is specifically influenced by compromised emotion processing and tolerance, identity diffusion, fluctuating sense of agency, reflective ability, perfectionism-related self- esteem, and ability to symbolize. The aim of this article is to review research studies with relevance for internal processing related to disordered narcissism and integrate findings with therapeutic strategies in alliance building with these patients.
El propósito de este trabajo es establecer algunas consideraciones sobre el trauma, la realidad histórico-vivencial, su simbolización y el dolor psíquico que genera la investigación de los procesos inconscientes en el tratamiento psicoanalítico. Estos temas serán tratados mostrando las diferencias que surgen entre las experiencias traumáticas y su expresión en la fantasía, acontecidas en un caso de neurosis y otro de psicosis. También estarán en consideración las diferencias en las características de la simbolización y de los procesos de elaboración en cada caso. Serán tratadas, especialmente, las dificultades específicas que le plantean al analista el abordaje interpretativo del trauma por el monto de dolor psíquico que provoca en el paciente y que resulta, por momentos, una barrera infranqueable o una distorsión destructiva del proceso.
This paper seeks to advance some considerations on trauma, historical reality, its symbolization and the psychic pain generated by the investigation of unconscious processes in psychoanalytic treatment. These themes will be explored by demonstrating the differences arising between traumatic experiences and their expression in phantasy, as they occurred in a case of neurosis and another of psychosis. In each case, the differences in the features of the symbolization and the processes of working through shall also be taken into consideration. Particular attention shall be paid to the specific difficulties encountered by the analyst in the interpretative treatment of the trauma resulting from the amount of psychic pain induced in the patient, which at times proves to be an insurmountable barrier and a destructive distortion of the process.
Résumé L’auteur traite de la difficulté d’articuler les concepts de trauma et de fantasme. Il évalue les observations freudiennes concernant le hasard et le trauma. Il examine les effets traumatiques du hasard en lien avec la rupture d’un fantasme narcissique d’invulnérabilité. Le récit d’événements traumatiques peut éveiller chez l’analyste une tendance à répéter l’agression, sur le sujet, de ces événements traumatiques. Une interprétation accusatrice peut être l’un des moyens d’opérer cette répétition. L’auteur explore un type de trauma essentiellement lié à la perturbation de la structure qui contient les idéaux du sujet. Cette perturbation est une conséquence de la désillusion résultant de la perte d’un objet dépositaire de ces idéaux. Le trauma entraîne un état de deuil des idéaux perdus. L’auteur décrit des événements traumatiques survenus chez un patient à la puberté ; des comportements paradoxaux des parents entraînèrent de nouveaux traumas pour le patient. La réticence à l’exploration des rejetons inconscients et à l’investigation des significations symboliques possibles a constitué le problème central dans l’analyse de ce patient. L’auteur discute la question des troubles de la symbolisation et examine la question des projections identificatoires provenant des objets primaires de ces patients.
In this paper, I will consider a type of misunderstanding in the analytical dialogue and the possible unconscious motivations underlying this. I will also make reference to the patient's use of the analyst's words for the purpose of narcissistic enactment and will explore the extent of the analyst's involvement in this. The subjects of misunderstanding and narcissistic enactment will be dealt with in relation to a patient's way of processing certain interpretations at the beginning of analysis and the concealment of her way of processing the analyst's words. By contributing dreams and other significant material in the sessions, the patient gradually revealed her phantasies which enabled the analyst to uncover the possible factors which determined her particular attribution of meaning to the analyst's words and her retention of information about how she had initially construed his interpretations.
The author deals with the difficulties in combining the concepts of trauma and phantasy. He evaluates Freudian observations relating to chance and trauma. He considers traumatic effects of chance in relation to the rupture of a narcissistic phantasy of invulnerability. The narrating of traumatic events may awaken in the analyst tendencies to repeat the aggression of these traumatic events towards the subject. The accusatory interpretation can be one of the means by which this repetition is established. The author explores a type of trauma which is essentially related to the disturbance of the structure which contains the ideals of the subject. This disturbance is a consequence of disillusionment resulting from the loss of an object who was the depository of these ideals. Trauma generates a state of mourning for lost ideals. The author describes traumatic events which occurred in a patient's life at puberty; paradoxical behaviours in the patient's parents caused the patient to have new traumas. The reluctance to explore the derivatives of the unconscious, and to investigate possible meaning in symbols, was a central problem in this patient's analysis. The author discusses disturbances in symbolization, and he examines the subject of projective identifications that were received by patients from their primary objects.
This article highlights the analysis of the patient's experience of the analyst's subjectivity in the psychoanalytic situation. Just as psychoanalytic theory has focused on the mother exclusively as the object of the infant's needs while ignoring the subjectivity of the mother, so, too, psychoanalysis has considered the analyst only as an object while neglecting the subjectivity of the analyst as the analyst is experienced by the patient. The analyst's subjectivity is an important element in the analytic situation, and the patient's experience of the analyst's subjectivity needs to be made conscious.
"Projective counter-identification designates the result of an excessive projective identification in the patient, not consciously perceived by the analyst, who, in consequence, finds himself 'led' passively into playing a role which the analysand, in an active, although unconscious manner, has 'forced' into him." Some cases in which this situation perturbs the interpretative process are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Countertransference is evidence of neurotic residuals which are to be expected even after training. The training should have the effect of enabling the analyst to "sustain his feelings as opposed to discharging them like the patient." Continued self-analysis is necessary. "I have traced the analyst's disturbed feelings in the counter-transference to a time lag between unconscious and conscious understanding." (PsycINFO Database Record (c) 2012 APA, all rights reserved)
It [my writing] is, I think a fairly representative sample, a derivative, of the French psychoanalytic movement of the second half of the twentieth century. And this is what I would like to impart to the Anglo-Saxon reader on the threshold of this translation.
When an analyst assembles a number of papers into book form, he becomes aware of a curious phenomenon. This collection, which gathers together papers that stretch over more than a decade, reveals that ideas which seemed at the time to be developing in a new way, when compared with earlier works, had in fact already been germinating many years before in a previous article. Of course the idea, when first formulated, existed only in a rudimentary form, and one would not have thought it would finally take on such importance.
Every analyst is aware of the psychoanalytic process within the cure. It could be that, for the analyst who writes, a psychoanalytic process exists which does not reveal itself through his self-analysis alone. I propose to call it the theoretical psychoanalytic process. One owes one's personal style of thinking to this process. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Traducción de: Le seminaire Reimpresión en 1983 Libro 1: Los escritos técnicos de Freud, 1953-1954
This presentation focuses on the superego pathology frequently present in patients with borderline personality organization, an important issue in transference developments that evolve as a consequence and expression of this pathology. I shall describe 'psychopathic transferences' to refer to periods in the treatment when conditions of deceptiveness prevail in the transference, and the importance of systematically interpreting and working through these particular transferences. As a result of such a working through, paranoid transferences usually become dominant, and, in turn, need to be worked through fully. At this point, more advanced transferences characterized by depressive features tend to prevail, signalling the structural transformation of borderline into neurotic personality organization. Clinical case material will illustrate these transformations in the transference.
In this paper I suggest that analytical material implicitly carries in it a message proceeding from the unconscious and which is transmitted through representations. The message is expressed only when the object is recognized as such by the subject. In the narcissistic situation the unconscious message is not emitted. The analysis of the analytical discourse shows that the narcissistic subject does not recognize the other as the object of the unconscious dialogue. Narcissism reaches its maximum expression in material empty of unconscious meaning. Narcissism is accomplished only by the collaboration of a subject and an object who have established a tie with the aim of maintaining the illusion that this subject can dispense with all objects. This tie is set up on the patient's side by means of the discourse empty of unconscious meaning and on the analyst's side by the pseudo-interpretation. The narcissistic self-esteem resides in the complacency which the patient obtains by keeping the verbal account deprived of unconscious meaning. When the analyst fails to show up the narcissistic resistance, he contributes to the establishment of this pathological self-valuation. Narcissistic regressions always include identifications and in this they differ from the anobjectal stage that regression attempts to reach.
This paper develops the idea that a state of impasse is the objective towards which the patient tends and that this is in response to an unconscious fantasy whose essential aim is to paralyse the object's autonomy and the bond. The fact that in some cases this objective is brought about with the unconscious participation of the analyst is pointed out. This unconscious participation is distinguished from the conscious emotions that permit the diagnosis of the impasse. The manifest content of the verbal material reveals typical features of these states. One of them is the lack, or marked diminution, of representations expressed through visual images. When the representations become evident in the verbal material, it is a sign that the impasse is over and that the process has temporarily resumed its course. The process has unconscious representations which, on becoming evident, reveal the state of deadlock or development through which it is passing. The representations of the impasse situation are typical. Some of these, such as objects endowed with circular movement, static bodies lacking mobility, are pointed out. Verbal material is differentiated in two categories depending on its capacity to transmit or to conceal contents belonging to the unconscious. Material devoid of meaning is inherent to resistance. When the analyst is unconsciously involved in the patient's impasse, he tends to favour a kind of dialogue which is lacking in meaning and symbolic value. The symbol-forming function is not affected.(ABSTRACT TRUNCATED AT 250 WORDS)
A number of recent revisions of psychoanalytic theory implicitly draw on postmodern conceptualizations of human selves and human subjectivity. Though postmodern ideas have a wide currency in the humanities and in literary criticism, and are increasingly represented in critiques of science, psychoanalytic clinicians are generally less familiar with the body of writings that encompass postmodernist thought. This paper discusses the evolution of postmodernism and its emergence into psychoanalytic theory using the work of Roy Schafer and Irwin Hoffman as cases in point. I will suggest that when postmodernism is applied to psychoanalytic practice, the result is only a partial solution, at best, to the problems of metapsychology postmodernist revisions were intended to resolve.
In this paper first presented in 1953 and now translated into English for the first time, the author gives an account of the phenomena that occur when the meaning of 'associating', 'interpreting' and 'words' is investigated. Her presentation is modelled on the manner of appearance and understanding of these phenomena. Because interpretation of a new aspect has always preceded its intellectual understanding, frequent repetitions will be observed, and one theme is sometimes adumbrated within another and developed more fully later. For all its drawbacks, such an exposition has the advantage of coming closest to reality. A schematisation would be premature and tend to conceal any errors, thus impeding subsequent understanding of the phenomena concerned. The author discusses the phenomena in their order of appearance. Although the order was the same in every case, she does not rule out the possibility that this might be because of her personal approach. The bibliography lists works that stimulated her interest and were particularly useful in the understanding and formulation of her work.
The notion of objectivity has fallen out of favour to some extent, with an increasing emphasis on post-modern trends such as social constructivism, intersubjectivity and perspectivism. In this paper it is argued that the notion of objectivity is still useful in the psychoanalytic domain and that psychoanalysis can and should have a healthy dialectical tension between modern and post-modern themes. The origin of objectivity in the term object is often overlooked. The analyst's position as an object, external to the thinking mind or subjectivity of the patient, offers a vantage-point from which the analyst can share observations that are different from the patient's by virtue of being external to the patient. Indeed, the patient's unconscious intentions are often most accessible through the analyst's careful scrutiny of his or her 'object' responses. Even though the analyst cannot transcend the intersubjectivity of the analytic couple, part of that intersubjectivity involves a perspective outside that of the patient.
The author suggests that, increasingly, contemporary psychoanalysts have been acknowledging and examining the intersubjectivity of the clinical encounter and that this trend has sometimes been misunderstood as necessitating the conclusion that objectivity is impossible to achieve in clinical psychoanalysis. In contrast to this, the author proposes a pragmatic definition of the analyst's objectivity that is entirely consistent with acceptance of the analyst's irreducible subjectivity, and illustrates his view by means of a clinical example. He suggests that objectivity concerns both objects and objectives, and indicates that a pragmatic conception of objectivity is employed throughout modern science. He explains why he regards psychoanalysis as a science, rather than as a hermeneutic discipline. He takes up the way in which implicit positivist assumptions can disadvantageously influence our thinking about the relation between an analyst's subjectivity and an analyst's objectivity. Finally, he discusses the important role of consensus in objectivity generally and in psychoanalytic objectivity particularly, as well as some of the differences that exist among analysts with regard to the specific objectives that take priority in clinical work.
The narcissistic resistances in the clinical experience and the supposed autonomy of the patient to reproduce the narcissistic stage are studied in this paper. The problem is examined through the analysis of a patient, who masturbated compulsively. The relationship between the symptom and the transference is investigated because the symptom related to specific behaviour from the object, and in order to understand the meaning of the phantasy that underlines the auto-erotic activity. It is pointed out that, in order for defensive activity to fulfil its sense of narcissistic refuge, an other (distinct from the subject) must carry out an essential function of support of the narcissistic defence. Narcissistic self-sufficiency is governed by a paradox, as it needs an object to demonstrate that it can subsequently dispense with this object. A second paradox occurs when the narcissistic subject can only succeed in dispensing with the object if the object gives some sign indicating that he is affected by such 'doing without'. In the analytical relationship, this type of defence manifests itself as narcissistic resistance. The analyst participates in the covering-up of the dependency that the defensive system has on the external object and this is a prerequisite for establishing the resistance.
This paper deals with certain distortions in communication generated by mutual recrimination that is the result of disturbances in the ideal agencies of both parties. Although the ideal ego, superego and ego ideal participate equally in reproach, it is the latter which is the most decisive. In clinical experience, recrimination may easily colour the analytic dialogue. In such cases, interpretation loses its sense of clarification and another type of dialogue replaces it. There, words are used to take possession of the other, for its autonomy is a threat to the static character of the pathology of mourning. The problem of recrimination has also tainted the development of psychoanalysis, to the point of disrupting the process of discovery itself. This paper deals with repercussions in the psychoanalytic movement and also in the elements that constitute its structure. Finally, different variations and disturbances in the psychoanalytic ideal are considered, as well as the involvement of the psychoanalytic institution in preserving or transforming the ideal. Here the importance of institutions and institutional ideals is emphasised. Finally, we suggest that ideals either encourage or hinder the working through of individual and collective mourning.
This paper explores the unconscious agreements between patient and analyst that promote some aspects of conflict to be excluded from the content of the interpretations. This generates an experience of exerting omnipotent control over the analyst, which subsequently consolidates a narcissistic phantasy. A stagnation of the analytic process is established in the course of the analysis but this remains hidden by areas of partial progress in the patient. Clinical material is provided in order to show the vicissitudes of the interrelationship between patient and analyst. It also demonstrates the working through by the analyst of a situation of both transferential and countertransferential conflict. This leads to an inhibition on the part of the analyst in his interpreting function. The use of projective identifications, which are mutually contradictory and incompatible, is also under discussion. This, as a result of being expressed simultaneously, constitutes a paradox, which may lead the analyst to confusion and an experience of paralysis. The subsequent confusional anxieties are considered. Additionally, authoritarianism is discussed, including its attendant difficulties of establishing boundaries between the self and the object. Finally, under consideration is the risk one takes in formulating authoritarian interpretations, which, in certain cases, can impose criteria on the patient.
While this paper has emphasized the importance of the Oedipal prob-lems in the production of imposture, it should be stressed again that one might better refer to these as the effects of an Oedipal phase than the effects of the Oedipal relationships. The acting out of the impostor is largely an attempt to achieve a sense of reality and competence as a man more than to claim the mother in any deep sense. From the material of my analytic cases, it seemed indicated that the mother might be a phallic mother and that in so far as the child was closer to her than to the father and might identify with her phallus, this increased the whole quality of illusion with which the impostor paradoxically struggles ful-some self-realization. It will be noted that this paper has dealt more explicitly with cases from history or from reports of others than from my own. This was un-fortunately necessary since after a number of years of analytic practice and with a number of published articles, it becomes increasingly dif-ficult to give the rich full clinical details that one would wish. This is particularly true when so delicate a subject as imposturous tendencies and impostures is involved. Patients tend to become aware of the ana-lyst's writing and may later look for themselves in clinical publications. While it would be unfair to publish anything without the consent of the analysand, this still does not resolve the problem. To see their own life histories in print may, in any event, be too great a narcissistic injury even though permission has been given for such publication.
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