Psychoanalytic Work Research Articles

A forgotten review by Sándor Ferenczi: “Otto Gross: Three essays on internal conflict” (1920)

ABSTRACT In early 1920, Otto Gross published his last book, Three Essays on Internal Conflict, almost at the same time as “Beyond the pleasure principle”, in which Freud revised his drive theory. Gross was one of the most brilliant analysts of the “first generation”, but he had spent more than 10 years outside the psychoanalytic movement, and no one showed any interest in his publications except Ferenczi, who immediately wrote a critical review that has never been translated into English. Here we present the first English translation of Ferenczi’s review, “Otto Gross. Three essays on internal conflict” (1920), first published in Internationale Zeitschrift für Psychoanalyse. In this review, Ferenczi shows a great deal of interest in the new approach proposed by Gross based on the recently discovered “hospitalism syndrome”, identifying the “instinct (or drive) for contact” as the origin of infantile sexuality. This review reveals a key moment in the trajectory of Ferenczi’s work, when he took a definitive turn towards investigating early relationships and towards a renewed focus on the trauma factor. This illuminates the rest of his psychoanalytic work and formed the foundations for the attachment and relational approach in psychoanalysis.

The Hero Transformed: The Dialectics of Heroism and Psychoanalytic Process in Working with Israeli Men

ABSTRACT This article examines the meaning of the heroic in the Israeli context. I will describe the meaning of the heroic as it appears in my psychoanalytic work with Israeli men. The heroic in this context looms large, it becomes a passion and a mission celebrated at the level of the individual and the social. Myths of heroism sustain hope and agency, as they also help sustain the dissociation from suffering. Heroism appears as an intrapsychic dialectic that may enhance and express vitality and personal agency, as it may also enhance grandiose and persecutory ideals. The heroic is at the same time a powerful social construction intertwined with the idiosyncratic history of the individual. Clinical examples are used to demonstrate the dialectics of heroism in the Israeli context, and the process of transformation of idolization of military heroism in the course of psychoanalytic treatment.

Investigating the impact of a psychoanalytic nursing development group within an adolescent psychiatric intensive care unit (PICU)

ObjectiveTo evaluate the impact of an adapted psychoanalytic work discussion group for mental health nurses working in adolescent PICU. BackgroundThere is no prior research investigating interventions that effectively support and enable adolescent PICU nursing teams to sustain the therapeutic tasks of their work and their own sense of wellbeing. MethodsA bespoke psychoanalytic work discussion group was implemented within an adolescent PICU. Data was collected using in-depth semi-structured interviews with participants, about the impact of the group upon their practice. Data analysis used thematic analysis. ResultsThe group positively impacted upon participant knowledge and understanding, emotion management, personal efficacy, therapeutic relationship building, managing challenging behaviour, leadership, professional identity and team cohesion. ConclusionMechanisms by which these outcomes were achieved are elaborated utilising the concepts of projective identification, emotional containment and ‘temporary outsider-ship’. There is a need to account for the interplay between adolescent defense mechanisms, nursing anxieties and setting-specific organisational dynamics, in the design of effective support interventions for adolescent mental health nurses.

Make Someone Happy: Reflections on Giving and Receiving in Love and Psychoanalysis

The balance of giving and receiving in social relationships, with each person knowing they can rely on the other when in need, is at least in part what makes a relationship durable and enduring. This principle applies as well, I argue, to the therapeutic relationship, even though mutuality in psychoanalysis involves its own uniquely complicated dynamic of giving and taking. Using an extensive clinical vignette, this chapter explores the ways that learning and growing takes place both for therapist and patient in the course of psychoanalytic work.

When the Body Keeps the Score: Some Implications of Trauma Theory and Practice for Psychoanalytic Work

ABSTRACT Trauma has wide-ranging effects on somatic functioning, nervous system regulation, relational engagement, and personality integration. This article provides an overview of how posttraumatic dysregulation and dissociation limit patients’ ability to engage in an analytic process, potentially leading to prolonged, stalled, or ruptured treatments. In this context, it offers suggestions for integrating insights and techniques from trauma therapies into psychoanalytic work, focusing on interventions that help people modulate posttraumatic reactions and so build their capacities to work through trauma’s impact.

Consenting and Assenting to Psychoanalytic Work

The moment is opportune for a renewed look at what we understand about patient consent to treatment. Until recently, little reference to informed consent could be found in the literature, as though it has never been a preoccupation for psychoanalytic practitioners. Yet several post-Freudian authors offer reasons to suppose the risk of misunderstandings about consent. In fact, the very discovery of transference, replete with unrequited infantile wishes, implies that at some level, at some moment, in every psychoanalytic treatment there will be moments when "consent" will to some extent vacillate. A distinction, justifiable on etymological and intersubjective grounds, is made between patients' consent as a cognitive, somewhat passive, acceptance and patients' assent as an arduous, conflicted, partial disagreement with the symbolically limiting details of analytic work. It is in the discovery and working through of unexpected unconscious responses to aspects of the analytic setting and to the analyst that patients become "informed" of the unique risks to their psychic equilibrium the process poses, as well as its benefits. Instead of a static and unitary contractual event, informed consent in psychoanalysis is more properly conceived as a multilayered, repetitively posed, and necessarily ambivalent process of good-enough assenting over time.

The Courage to Dream: A Beginning Psychotherapist Encounters Bion

In this paper, a psychotherapy student is given an assignment to analyse one of her own dreams using Freudian dream theory. She struggles to engage with the task until she discovers the ideas of Wilfred Bion. The notions of alpha function and beta function offer a framework for the student to understand why she has had so much difficulty in staying connected to her dreams or delineating in a culturally appropriate way between what is reality and what is her dreamworld. The student questions whether her early life, taking place within the political and ideological conflict of apartheid‐era South Africa, may have influenced her ability to stay in reality, and wonders about her own ability to contain the affects of her children. She presents a vignette of a dream of her own in which she has to free a naked baby who is stuck in a wall in a bathroom. The writer and her therapist construct the dream as aligning with her own psychoanalytic work to integrate the very young part of herself. In coming to this understanding with the ideas of Bion, the student experiences her own reality in a more vivid and present way.

The perverse and the psychotic superego

ABSTRACT In this contribution I will sustain that, given its origin, meaning and function, the superego is readily susceptible to the pathological distortions observed in clinical psychoanalytic work. After all, while we as psychoanalysts are unacquainted with the “normal” superego, we are accustomed to seeing patients with either an abnormal sense of guilt or a seeming absence of guilt. However, a distinction must first be drawn between the primitive superego and its pathological counterpart. Whereas some clinical situations involve a superego whose primitive aspects feature prominently in the foreground, in other cases one encounters psychopathological structures that do not stem from the primitive superego, even if they share the latter's seductive, dominant or intimidatory aspects.

Empty Time as Traumatic Duration: Towards a CinematicAevum

Frank Kermode uses the term aevum to question the links between origin, order, and time, associating experience with spatial form. Without end or beginning, aevum identifies an intersubjective order of time where we participate in the “relation between the fictions by which we order our world and the increasing complexity of what we take to be the ‘real’ history of that world”; being “in-between” time is a primary quality of the aevum. Regarding cinema, aevum identifies this third duration as emotional experience, occuring as traumatic time. It facilitates thinking beyond lived temporal experience of everyday life to a philosophy of experience that accounts for alternative sensoria of time, similar to the traumatic encounter. The cinematic aevum is equally not of the material, corporeal world; concurrently associating human reality with the myths of the human condition. To say that a cinematic aevum exists following traumatic scenes, is to specify a visual “time-fiction” in film, to recognise a spatial form that belongs neither to the finite time of the film's narrative, or of the “eternal” time outside the film's diegesis, but participates in the order (and linking) of both. Wilfred Bion's psychoanalytic works are used to discuss the traumatic symptom of “empty time”: the inability to recollect, to make links between memory and experience, demonstrating a version of empty time that works as an external violence to spectator perception. Bion's theories offer fresh psychoanalytic perspective on trauma and its relationship to time by challenging classical ways of thinking about inner and outer perception.

How Much Time Do We Need? Time and Psychoanalytic Psychotherapy in CAMHS

The author considers what seem to be norms and values concerning session frequency and length of treatment in ‘traditional’ and current child and adolescent psychotherapy practice, and the impact of training expectations and models of training on identity and status as a child and adolescent psychotherapist. In the UK National Health Service, there is pressure to do more in less time: the norm is once‐weekly work. Such an expectation does not sit comfortably with psychoanalytic theory and training, which remains rooted in higher frequency, longer‐term cases. For trainees, this can lead to feelings of fraudulence and questioning whether less frequent therapies imply that the work is not psychoanalysis. The author explores, through a literature review, a case study and research material, how one might acknowledge the tension between these conflicting values about time; how psychoanalytic work in all its forms might be valued and be valuable for patients; and urges the need to feedback clinical experience into training structures and ongoing learning.

Chiasmatic Crossings Between Freud’s Clinical Projects and Social Concerns

The culturally informed metapsychology of Freud’s is horizonal (sic) with psychoanalytically informed accounts of social concerns but not interchangeable. There are limits, to be sure, but evocative and informed chiasmatic crossings between them are generative and serve both fields of psychoanalysis and social thought. Psychoanalysis gives us access to the tragic inner life of humans and their capacity to love and betray, create and kill, among other acts of humans. The psychologically-charged world of social concerns is but an external field of reference that resonates with internal world representations. Inside and outside fold into each other to create a spiral circularity of events and psychological configurations that can be resubjectivized in accounts of human nature and the civilizing process in both psychoanalytic work and practices of social theory.

Mitigating racial loneliness as transformative psychoanalytic work

Racial loneliness is a phenomenon experienced by individuals of color in predominantly white settings, including the predominantly white clinic. This paper identifies key psychoanalytic underpinnings of racial loneliness, drawing upon theory from Klein, Fanon, Layton, Eng and Han, and Okun. In doing so, this paper explores racial loneliness and its treatment implications. Through a deepened understanding of racial loneliness, the isolation and exclusion of clinicians of color within psychoanalysis is interrogated. A clinical vignette is deployed to explore the effects of racial loneliness on treatment, identifying unique challenges in the realms of countertransference, self-disclosure, and identification.

The Reality Principle: Fanonian Undoing, Unlearning, and Decentering: A Discussion of “Fanon’s Vision of Embodied Racism for Psychoanalytic Theory and Practice”

This response argues that attention to the ideological misattunements in psychoanalytic work helps us move beyond the symbolic—and that which it hides—into the real, material implications for our patients. By discussing Waverley’s hyper-corporality especially in relation to Knoblauch, his White analyst, we can mark a real vs. symbolic recognition of the expansiveness of Whiteness and the ways in which it aims to recenter itself in our theory, practice, and training. More specifically, using Knoblauch’s (this issue) moving account of a moment of “misrecognition,” this response takes up the ways in which Whiteness materializes an ideological apparition that aims to invert the visible-invisible spectrum.

Can I Touch You Through A Screen? A Discussion of “Video Communication and Transgenerational Shame in the Mother/Daughter Bond”

This discussion elaborates on the complexity that electronically mediated treatment adds to Psychoanalytic work. The author explores the fate of the body in a Skype relationship, with particular attention to dilemmas posed by work with erotic transference when the transgressive excitement of possibility – actual erotic contact between analyst and patient – is absent. Additionally using Goldberg’s understanding of the frame as contact barrier, the author considers Skype as both frame and process and elaborates on limitations posed by Skype in adjusting to the phenomenology of the clinical moment. Ways to vitalize the frame over Skype are suggested. The author’s concerns about Skype treatment with dissociated and traumatized patients are also explored, and unrecognized enactments in Ringel’s work with D are considered, as is the possibility that work over Skype with D may have reified disconnection rather than promoted is intimacy.

Being an Analyst: A Journey of Outsidership, Topology, and Time

ABSTRACTThis article explores psychoanalytic work via a trio of themes – outsidership, topology, and time – in the context of psychoanalytic practice and organization in Ireland. Focusing on the centrality of speech and language in approaching subjectivity via the work of Freud and Lacan, this article contemplates what being an analyst means, how psychoanalysis works, and how it is distinguished from other therapeutic approaches. The article takes up Freud’s emphasis on the importance of exile or outsidership in informing the analyst’s orientation to the unconscious. The notions of topology and time are helpful in exploring the psyche, unconscious formations, and instances of subjective significance in terms of their symbolic determination and the limitations of their representability.

Freud Does Disney

Dumbo tells a coming of age story about a young elephant who must gain psychological independence from his mother; Fantasia consists of eight episodes on various subjects, but they are strung together with the image of the conductor, Leopold Stokowski, and his (famous) hands. Two of the episodes (Nutcracker Suite and Night on Bald Mountain) dramatize the use of hands in controlling the actions of others. I elaborate on these issues using the psychoanalytic work of Erik Erikson, Ernst Kris, John Bowlby, and Norman Holland and introduce material on the neuropsychology of motor control.

The Anna Freud National Centre for Children and Families (AFNCCF) Parent–Toddler Group model in a homeless hostel

ABSTRACT This paper describes psychoanalytic community work, through a parent–toddler group run in a homeless hostel. The theoretical background and context for the group are explored, as well as the challenges that present in this type of work and the interventions developed to meet these.

The Psychoanalytic Education of CAPA Graduates

ABSTRACTThe CAPA Psychodynamic Psychotherapy Training Program and the evolution of Internet videoconferencing applications have inspired and enabled graduates of its advanced program to seek distance psychoanalytic training, mainly in approved institutes of the American Psychoanalytic Association. Two forms of training, Formal Distance Programs and Distance Accommodation, are described. Distance analytic training presents technical and pedagogical challenges to institutes and to their faculty. Some of the objections to distance education that hamper participation by essential faculty are presented. These issues are discussed and remedies are suggested. With experience, these challenges can be addressed and the training experience becomes satisfying for faculty as well as students. The candidates themselves, in two letters, describe their positive experiences in simultaneous training. A sample of clinical work brought to supervision by a distance candidate in the early years of training is presented to give some sense of the aptitude for psychoanalytic work that exists among distance candidates. Some preliminary thoughts about the variations in the psychoanalytic processes are raised and will need to be supplemented by further experience.

Creative States of Mind: Psychoanalysis and the Artist's Process by Patricia Townsend, and: The Outwardness of Art: Selected Writings of Adrian Stokes ed. by Thomas Evans

Reviewed by: Creative States of Mind: Psychoanalysis and the Artist's Process by Patricia Townsend, and: The Outwardness of Art: Selected Writings of Adrian Stokes ed. by Thomas Evans Janet Sayers (bio) Creative States of Mind: Psychoanalysis and the Artist's Process by Patricia Townsend, 2019, London: Routledge, 136 pages. The Outwardness of Art: Selected Writings of Adrian Stokes, edited by Thomas Evans, 2020, London: Ridinghouse, 608 pages. Outside In: Art and Psychoanalysis Psychoanalysis is often criticized as incorrigibly introspective. Nor is this any surprise given its origin in Freud's focus on his inwardly-occurring dreams, and on the focus of today's psychoanalysts on the inner world of their patients. Yet, even in his very first work of psychoanalysis, Freud drew attention to the external stimuli causing dreams. Examples included a medical student who, hearing as he slept his landlady calling him to wake up, dreamt he was already at the hospital where he worked so there was no need for him to wake up and go there. Impressed by the external and other stimuli provoking dreams Freud likened their effect on the unconscious mind to the relation between an entrepreneur and a capitalist of which he said [T]he entrepreneur, who, as people say, has the idea and the initiative to carry it out, can do nothing without capital; he needs a capitalist who can afford the outlay, and the capitalist who provides the psychical outlay for the dream is invariably and indisputably, whatever may be the thoughts of the previous day, a wish from the unconscious. (Freud, 1900, p. 561, emphasis in original) Freud famously went on to describe ways that psychoanalysts can evoke more or less unconscious feelings in their patients about other significant people in their lives. He first described these outwardly-evoked, inwardly-occurring feelings [End Page 809] as "transferences" in trying to understand why his patient, Dora, gave him notice just as she did a family friend, Herr K (Freud, 1905, p. 116). This passage in Freud's 1905 case study of Dora is well known by many Freud enthusiasts. Much less well-known and often overlooked is Freud's speculation, in a book published in 1909, about the external stimuli shaping the art of Leonardo da Vinci. In particular Freud speculated that meeting the subject of his painting, Mona Lisa, evoked in Leonardo's memory "the smile of bliss and rapture which once played on his mother's lips as she fondled him." It was this, said Freud, which caused Leonardo to give the same smile "to Leda, John the Baptist and Bacchus" in his paintings of them (Freud, 1910, p.117). I am reminded of this aspect of Freud's psychoanalytic account of dreams, transferences, and the art of Leonardo by the artist and psychoanalytic psychotherapist Patricia Townsend's recent book Creative States of Mind: Psychoanalysis and the Artist's Process. In it she draws on the psychoanalytic work of Marion Milner, Donald Winnicott, Christopher Bollas, and others in reporting results of her interviews with thirty-three artists, several of whom described their artwork being inspired by 'finding something in the outside world' which for them had "a special meaning" (2019, p. 7). The same is true, it seems, of several of Townsend's own artworks inspired by seeing England's Morecambe Bay from nearby mountains, a sight of which she says There was something troubling about this landscape. Was it the history of the Bay, the fact that many lives have been lost here to the quicksands or to fast incoming tides? Looking out over the great expanse of the Bay at low tide, I imagined myself walking out alone towards the horizon until I could see no land. I imagined what it might feel like to be out in this wet desert, far from help. This sense of isolation and lack of containment seemed to be one aspect of my emotional reaction to the Bay. Another had to do with the imagined experience of being sucked beneath the ground by quicksands. Or being swept away, engulfed, by the incoming tide which [End Page 810] is said to be as fast as a galloping horse. But I felt that...

The House-Drawing Test: Using a projective test in assessment to differentiate normal from pathological ageing

This article proposes to show how the use of the drawing of the home can help differentiate two older populations, with or without cognitive impairment as part of research to identify early signs of Alzheimer's disease. The projective test of the house is complementary to the cognitive assessment. Two groups of older adults are compared: an experimental group with 24 people aged 67 with cognitive impairment and a control group with 36 people aged 71.5 years with normal cognitive aging. Analysis of the house drawings revealed significant differences in the realization of the drawings between the control group (CG) and the experimental group (EG). The characteristics of the drawings of elderly people with cognitive impairment show more difficult access to imagination and a feeling of insecurity as of the first memory impairment. This article puts the body at the center of psychoanalytic work and explores the relationship between the psychic and bodily dimensions of elderly subjects using a projective spatiography test. This projective tool allowed us to collect information on the psychic functioning of the elderly.