This case illustrates how cultural issues can influence the progression of psychodynamic therapy. During the course of supervision, the resident learns how understanding the cultural similarities and ...differences between patient and therapist both enhances and hinders the treatment. The supervisor demonstrates the utility of parallel process during supervision in general and as a tool to uncover key cultural issues. The Grand Rounds discussant highlights cultural aspects of the case such as psychotherapy in a second language, assumptions about traditional roles, and demonstrations of closeness. PUBLICATION ABSTRACT
By tracing a portion of close process of a patient's shifts from a relatively silent and inhibited stance to one in which he is beginning to verbalize more about his experience and fantasy, I will ...illustrate some tensions between the analyst's role as facilitating expressiveness and as occupying a place in the patient's internalized world. Since the analyst's functions as facilitator and as internal object (often an obstacle to the patient's expressiveness) are sometimes in conflict with one another, it is important for the analyst to be able to work internally with this conflict as he works with his patient. Splitting processes between these two functions may provide the analyst with cues related to the patient's and the analyst's resistance to understanding the patient's communication of unconscious conflict and the patient's recruitment of the analyst into the patient's internalized world.
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The author challenges the traditional and still prevalent view of 'free association', arguing that it entails three forms of denial (also formulated in terms of corresponding myths): 1) denial of the ...patient's free agency; 2) denial of the patient's and the analyst's interpersonal infl uence; and 3) denial of the patient's share of responsibility for co-constructing the analytic relationship. That responsibility includes some degree of consideration of the analyst's needs. Sometimes, the patient's good judgment to that end may be refl ected in what is automatically and mistakenly reduced to a form of 'resistance'. Attention to the patient's responsibility must be balanced against the effort to provide a uniquely safe environment for the patient's revealing of shame and anxiety-ridden feelings and attitudes. But the therapeutic action of psychoanalysis, ideally, includes the cultivation, through lived experience, of the dialectical interplay of self-expression, on the one hand, and caring relational engagement, on the other. Recognition of the patient's free agency does not preclude exploration of constraining structures laid down in the past. On the contrary, it deepens such exploration. At the same time, it opens the door to the possibility of explicit recognition, via challenge, criticism, or affi rmation, of the patient's contributions to the analytic work.
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494.
Death and mastery Fong, Benjamin Y
2016., 20161108, 2016, 2016-11-08, Volume:
61
eBook
The first philosophers of the Frankfurt School famously turned to the psychoanalytic theories of Sigmund Freud to supplement their Marxist analyses of ideological subjectification. Since the collapse ...of their proposed "marriage of Marx and Freud," psychology and social theory have grown apart to the impoverishment of both. Returning to this union, Benjamin Y. Fong reconstructs the psychoanalytic "foundation stone" of critical theory in an effort to once again think together the possibility of psychic and social transformation.
Drawing on the work of Hans Loewald and Jacques Lacan, Fong complicates the famous antagonism between Eros and the death drive in reference to a third term: the woefully undertheorized drive to mastery. Rejuvenating Freudian metapsychology through the lens of this pivotal concept, he then provides fresh perspective on Theodor Adorno, Max Horkheimer, and Herbert Marcuse's critiques of psychic life under the influence of modern cultural and technological change. The result is a novel vision of critical theory that rearticulates the nature of subjection in late capitalism and renews an old project of resistance.
At certain moments in his political essays, Kant conceives of socio-historical emancipation as a process of working ourselves out of pathological legacies, suggesting that emancipation would involve ...a process of working through our affective attachments to entrenched, regressive social arrangements. Jackson shows how Freud’s analyses of melancholia, mania and the work of mourning can contribute to an understanding of key dimensions of such pathological social fixations, as well as the possibility of working through the past. This book argues that bringing Freud’s provocative analyses of loss to bear on particular philosophical treatments of history leads to a more coherent, psychoanalytically informed understanding of history. Although Freud does not himself integrate these themes into a theory of socio-political emancipation, his thinking nonetheless can be read as contributing to such a theory. To develop this idea the book draws on thinkers such as Karl Marx, Theodor Adorno, Edmund Husserl, Martin Heidegger, Axel Honneth, and Judith Butler. The book engages students and scholars of contemporary continental philosophy by arguing for connections between psychoanalysis, philosophy, and critical theory.
Recognizing that enactments have been discussed in psychoanalysis primarily as occurrences in the treatment setting, the author proposes a new application of the term enactments: that it may pertain ...to the actions of some individuals in their efforts to cope with bad things that they have done to others. That is, enactment can be a substitute-for-atonement mechanism. The author illustrates this view of enactment through a discussion of Ian McEwan's novel Atonement (2001), and in particular by examining the behavior and motivations of one of its central characters, Briony Tallis. Included are explorations of the relationships between enactment and guilt and between enactment and reparation.
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Objective:
To examine whether men and women respond differentially to brief dynamic psychotherapy, with or without transference interpretations.
Method:
Data from the First Experimental Study of ...Transference Interpretation were used. Patients (n = 100) were randomized to receive 2 different dynamic psychotherapies during 1 year, with either a moderate level of transference interpretations or no transference interpretations. We used the following outcome measures: the Psychodynamic Functioning Scales, Inventory of Interpersonal Problems-Circumplex Version, Global Assessment of Functioning (GAF), and total mean score of Symptom Checklist-90-Revised (Global Severity Index GSI). Change was assessed using linear-mixed models.
Results:
On average, men and women responded equally across treatments. The moderator analyses, using the 2 secondary outcome measures, GAF and GSI, demonstrated that women responded better to therapy with transference interpretations, compared with men, whereas men responded better to therapy without transference interpretations, compared with women. When the moderator sex was combined with the moderator quality of object relations (QOR), a strong effect emerged: men with high QOR showed a large negative effect of transference interpretations, and women with low QOR showed a large positive effect.
Conclusions:
In terms of symptom change, women responded better to therapy with transference interpretations, while men responded better to therapy without transference interpretations. Patient sex showed moderator effects over and above the moderator effects of QOR.
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The erotic transference can be seen as the Janus face of clinical work in psychoanalysis: it may either arise out of the positive emotions necessary for the building of new shared realities, or be ...fueled by falsified and distorted constructions. In the former case, the erotic transference expresses the capacity to anticipate, or “dream,” the emotional relationship with the object—which is why Freud valued its transformative aspect as one of the “forces impelling the patient to . . . make changes”—whereas in the latter it is equivalent to a flight from psychic reality and may be imperceptibly transformed into an actual delusion.
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Sexual experiences, rather than being neutral, are specifically male or female. Yet at present no conceptual framework exists for representing female sexual desire. This has resulted in frequent ...misrepresentations of female sexual experience. To correct this, a labial framework is proposed, not to replace or oppose a phallic framework, but to exist alongside it. The lips of the mouth and those of the genitals provide a felicitous doubling of sexuality and speech to represent female desire and sexual pleasure as labial. Phallic and labial rhythms are organized differently in sexual arousal and desire, since, as Simone de Beauvoir put it, “Man ‘gets stiff,’ but woman ‘gets wet.’” The labial framework therefore represents female psychosexuality more in terms of “wetware” than of “hardware.”
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While all patients become more concrete in their psychological functioning in areas of conflict, especially in the setting of transference regression, in the treatment of patients with severe ...personality pathology this process poses a particular clinical challenge. In the psychoanalytic psychotherapy of patients with severe personality pathology in general, and borderline personality disorder in particular, the interpretive process serves multiple functions. This process comprises a series of steps or phases that can be viewed as moving the patient further away from a single, poorly elaborated, and concrete experience in the transference, which dominates and floods subjectivity, and toward more fully elaborated, complex, stable, and integrated representations of the analyst and of what he or she evokes in the patient's internal world.
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