Therapeutic Action Of Psychoanalysis Research Articles

Intersectionality and Relational Psychoanalysis: New Perspectives on Race, Gender, and Sexuality ed. by Max Belkin and Cleonie White

Reviewed by: Intersectionality and Relational Psychoanalysis: New Perspectives on Race, Gender, and Sexuality ed. by Max Belkin and Cleonie White Deborah Shilkoff, LICSW (bio) Intersectionality and Relational Psychoanalysis: New Perspectives on Race, Gender, and Sexuality, Edited by Max Belkin and Cleonie White Psychoanalytic metapsychology has changed in the past decades from an emphasis on drives as the source of intrapsychic organization, energy, and movement. The nexus of psychoanalytic theory has evolved from the intrapsychic to an interpersonal, intersubjective, and relational focus. With the evolution of intersubjective psychoanalysis, the bi-personal field of the analytic pair is now seen as the vehicle of intrapsychic growth. The relational field further evolved as the locus for development of the ego. An appreciation of the social milieu and its effect on the individual led to an understanding of the long arm of trauma on development. Relational psychoanalysis holds that one sequela of trauma is dissociation, the inability to hold overwhelming pain that threatens the ego with fragmentation. The individual's internal states are cut off from one another, disabling the ego from cohering. Self-states are not perceived as belonging to the individual but are felt to be "not me" states. Internal conflict cannot be accessed because it did not fully develop or because it was sidelined by overwhelming trauma. Affect regulation and thought are not available to stem the flow of traumatic fight/flight/freeze enactment. Philip Bromberg's "Credo" (2012) tells us that "the therapeutic action of psychoanalysis is a self–Other negotiation that takes place between and within analyst and patient at the interface of dissociation and the capacity to hold internal conflict" (p. 273). Bromberg counseled achieving a balance of "safety and risk" within the therapeutic alliance as the most effective analytic tool. Enactments are processed jointly with the goal of developing the capacity for thought and affect tolerance. [End Page 207] Complexity becomes available, and the world is no longer seen as monolithic and annihilating. Kimberlé Crenshaw (2016, 1991) is the originator of the term "intersectionality," which is a way to name and frame the complexity at the intersection of racism, sexism, classism, colonialism, ableism, xenophobia, and heterosexism. Without such a "frame," Crenshaw tells us, we lack an awareness, context, and empathy for the various states experienced by those in these overlapping categories. Not being able to see more than one part of the overlapping frame at a time results in deficits in or assaults on social justice. Crenshaw gives the example of Emma DeGraffenreid, an African American woman who was denied a job at General Motors. She sued GM for race and gender discrimination. The judge denied her claim, saying that GM did hire Blacks and women, so there was no discrimination, and he could not grant her preferential treatment. Crenshaw saw that the judge missed a key point. The Blacks hired by GM were all men who worked on the assembly line. The women, all white, were secretaries. GM had not hired Black women, a blind spot for both GM and the judge. Crenshaw saw this as an intersection in which Ms. DeGraffenreid was unacknowledged. The overlap with intersectionality and relational psychoanalysis is represented in the ability to see people and institutions as complex, with overlapping meanings. The contributors in this well-written book help us see how our unconscious sense of privilege limits our ability to see the intersecting vertices of our patients' realities. We then become part of the social structure from which patients may feel excluded. The revolutionary changes in both relational psychoanalysis and intersectionality, as outlined in this book, constitute both the ability to see complex structures as internal and external, and the function of bearing witness to trauma at many levels simultaneously. Each chapter represents a different focus, so each will be addressed separately. In "Queer Identities," Max Belkin says each category is a metaphor, not a binary stereotype that inhabits a transitional space. Our narrative is both "social" and "idiosyncratic." With his patient, Ana, both were in a "dissociative cocoon" of mutual hiding of their true selves from the other in a "fascinating but [End Page 208] disturbing hall of mirrors," competing with one another for the moral high ground of...

Donald Winnicott and Stephen Mitchell’s Developmental Tilt Hypothesis Reconsidered

ABSTRACT In this paper, the author revisits Stephen Mitchell’s important developmental tilt hypothesis in light of his treatment of Winnicott’s most creative contributions to psychoanalysis. It is the author’s contention that neither Winnicott’s focus on play as the central factor in the therapeutic action of psychoanalysis nor his role, along with Bion, of creating an ontological turn in psychoanalysis were accounted for in Mitchell’s reading of Winnicott. The author argues that in Mitchell’s useful attempt to redress some of the ways that regression had been concretized in psychoanalytic practice and theory, he overlooked Winnicott’s complex view of holding and the mutual elements of regression that occur between patient and analyst in play. Play embodies tensions between the symmetrical and asymmetrical elements of the analytic relationship in ways that Mitchell did not consider in his developmental tilt hypothesis.

Rethinking Therapeutic Action: Finding Commonalty in Diversity

Understanding what the therapeutic action of psychoanalysis and psychoanalytic therapy have in common with other forms of therapy helps us identify essential elements of therapeutic change. Several processes that cut across diverse psychotherapy approaches are outlined, based on clinical empiricism, theory, and research. A model of therapeutic action is considered that places emotion schemas at the center of therapeutic change across modalities; to modify these memory structures, diverse therapies utilize overtly different, if complementary, methods. These shared processes are drawn together into a common, coherent change model that is further informed by the role of neuroplastic memory reconsolidation. Although the model seeks to explain and to link multiple transformative therapy approaches, and in that sense, is a general model that applies to many therapies, for the purposes of this paper, the case example applies the model to psychoanalytic therapy. Paradoxically, the case illustration brings into sharpened focus what is important and often underemphasized in psychoanalytic therapy, while also opening and extending customary forms of psychoanalytic and psychotherapeutic thinking and methodology.

On Leading and Trailing Edge: Toward a New Conceptualization of What Is Curative in Psychoanalysis.

This paper seeks to establish that the therapeutic action of psychoanalysis derives from two sources: the work with the trailing edge and the work with the leading edge, concepts introduced by Tolpin. While the work with the trailing edge or the repetitive transference is what psychoanalysis has always focused on when defining the therapeutic action, the work with the leading edge, for which the concept of the generative transference is introduced, has remained underdeveloped.

In Recognition of Their Desperation: Sonic Relationality and the Work of Deep Listening

ABSTRACTThis essay places composer Pauline Oliveros’s philosophy and practice of Deep Listening in conversation with analytic theories of listening in a duet that explores one central question: What can listening do? Thinking through the impact of cultivated listening practices on the sensorium, the relational implications of listening across difference, and the centrality of practices of listening to the therapeutic action of psychoanalysis as well as the transformational capacity of performance, this essay claims Oliveros as a practitioner and theorist of a central psychoanalytic practice: listening. Deep Listening has the capacity to act as an amplifier for extending the reach of analytic listening beyond the clinic into an expanded cultural field. Likewise, psychoanalytic thinking allows for a rich exploration of the interpersonal and intrapsychic dynamics of Oliveros’s sonic meditations as they resonate in the circuits between the psyche and the social. Her 1970 composition To Valerie Solanas and Marilyn Monroe In Recognition of Their Desperation acts as a case study for exploring the dynamics of feminist listening.

From Ghosted Images to Ancestral Stories: Spectres and Narrators in Dickens' Great Expectations

From Ghosted Images to Ancestral Stories:Spectres and Narrators in Dickens' Great Expectations Gavriel Reisner (bio) I Visual Perception and Verbal Reception As the narrator and the protagonist of Great Expectations, Pip has two distinct identities. A speaker in the present and an actor in the past, his divided role creates narrative complexity. The two Pips separate and connect in a creative relationship that drives the novel. Tracing his development as it happens, Pip understands his story by telling it. The changes in self-understanding are reflected outward and seen, by both him and the reader, as changes in the characters around him. Thus, two contrasting ways of apprehending others are achieved in Great Expectations: first, the visual way, where others are perceived by their images, and, afterward, the verbal way, where they are experienced in their stories. We meet the character Pip as a suffering orphan when he is five or six years old. Early on his child's mind houses an imagination intimidated by frightening appearances—he receives speech more in the impression it makes than in the meaning it holds. The result is a superficial (supra/facial) or sur/face mode of perception. As he grows up, Pip moves into the story mode of reception, where he listens as well as looks. Taking in the words with their overtones, he achieves more complicated integrations in his way of understanding others. Like Pip, for this goes beyond a particular child-character to a wider human experience, we perceive others better when we receive their narratives, not limited to what we see, but open to what they say. Combining perception and reception, we [End Page 223] process impressions. Listening to stories we piece together a comprehensive tale comprised of memories and experiences, shared in the combined knowledge of listener and teller, and received by a sympathetic imagination to achieve a full narrative. II Time in Loewald, Space in Winnicott The movement from image to word in Dickens' novel finds a parallel in psychoanalytic theory. In his "On the Therapeutic Action of Psychoanalysis" (1960), Hans Loewald writes about ghosts and ancestors as two ways of understanding the parental figures within us.1 Among our inner objects, there are the ghosts who haunt us. Versions of bad parents, these are static presences trailing unresolved issues and calling us back into the past. Opposed to these ghosts are the strengthening ancestors, internal images of the good parent allowing an independent state of being demonstrated by the capacity to live in the present. Loewald traces the bridge from ghosts to ancestors in the process he calls internalization. Here the constructive influences from the past are strengthened in analysis itself; we grow in the analytic dialogue. We move forward in the presence of an insightful therapist who incarnates a lost or never found good parent. The movement from one mode to the other, in both Dickens and Loewald, necessitates a certain kind of supportive presence, a good object who is also a speaking object. That good parent, the ancestor, may underlie the bad parent, the ghost, but the lost connection needs to be found in dialogue with a current presence. In Loewald, we are talking about a temporal process, speech in time; this therapeutic action occurs within the subject over time working in language between past, present, and future. D.W. Winnicott notes the importance of a "good-enough" object, one who neither stays too far from nor comes too close to the subject. But where Loewald is notably concerned with time, Winnicott places development in space. Tracing growth in what he calls "going on being" (1956, p. 303), Winnicott [End Page 224] considers experience in the outer actuality of place, as well as experience in the inner abstraction of time.2 Not focusing mainly on therapeutic experience, Winnicott looks to developmental experience generally; yet, as in Loewald, the movement forward necessitates a supportive, non-interfering good object. We can enrich the concept of going from ghosts to ancestors by considering that all-important passage forward in relation to Winnicott's own notions around transitional or potential space and the good-enough figure who helps us negotiate the crossover. In the in-between area...

Introduction: Stumbling on our Past, Reflections on James Baldwin’s “My Dungeon Shook”

Introduction: Stumbling on our Past, Reflections on James Baldwin’s “My Dungeon Shook” Bernard Edelstein (bio) As I read “My Dungeon Shook,” my thoughts went to Hans Loewald and his beautiful description of a parental function in which the parent, holding a version of the core that the child presents to him, mediates a vision of growth and future. In “On the Therapeutic Action of Psychoanalysis,” Loewald writes: The parent ideally is in an empathic relationship of understanding the child’s particular stage of development, yet ahead in his vision of the child’s future and mediating this vision to the child in his dealing with him. This vision, informed by the parents own experience and knowledge of growth and future is ideally a more articulate and more integrated version of the core of being that the child presents to the parent. The more that the parent sees and knows, he mediates to the child, so that the child in identification with it, can grow. The child, by internalizing aspects of the parent, also internalizes the parents’ image of the child—an image that is mediated to the child in the thousand different ways of being handled bodily and emotionally. (1960, pg. 20) Hold that image next to the painful dilemma described by Baldwin in The Fire Next Time: Every effort made by the child’s elders to prepare him for a fate from which they cannot protect him, causes him secretly, in terror, to begin to await, without knowing he is doing so, his mysterious and inexorable punishment. He must be “good” not only in order to please his parents and not only to avoid being punished by them; behind [End Page 295] their authority stands another, nameless and impersonal, infinitely harder to please and bottomlessly cruel. And this filters into his consciousness through his parents’ tone of voice, as he is being exhorted, punished or loved; in the sudden uncontrollable note of fear in his mother’s or his father’s voice when he has strayed beyond some particular boundary. (1963, p. 40) I thought about “the talk,” a responsibility left to black parents to caution their children about police, to prepare them for a danger they encounter merely by virtue of their skin color. And thereby, the vision of future, of possibility and growth the parents mediate to their child, is burdened by an ongoing reality of trauma. In his always eloquent voice, Baldwin challenged White America to acknowledge its disavowed history of racism, and in so doing to have a conversation about the ongoing violence being imposed on their Black countrymen and the damage imposed on themselves. Yet, although Baldwin was widely read and celebrated by many, sixty years later we struggle as a society with the same disavowal and the destruction it wreaks. What is it about this inability, this refusal, to acknowledge the painful reality that has been with us for centuries, that expresses itself as a failure to remember, to see what is before us? Baldwin writes, “We are capable of bearing a great burden, once we discover that the burden is reality and arrive where reality is” (1960, p. 105). But we know as psychoanalysts that there is a powerful wish to bury that which makes us uncomfortable, or ashamed, or which leads us to feel we must give up narratives that we have long held to be true. In The Fire This Time (2016), a compelling collection of essays on race in America, Wendy Walters writes, in her essay entitled “Lonely in America,” about an African American burial ground in Portsmouth, New Hampshire, that had been struck from memory, seemingly from existence. Walters learned that while city workers were attempting to dig a manhole on a public street, a pine coffin had been discovered with leg bones protruding from the coffin. She found that in 1705 the city had approved a plan to create a Negro Burial Ground. By 1813, houses had been built on the site, and by the time Walters went to explore, and inquired [End Page 296] about the graves, presumably the graves of slaves, she was told, “You can’t see anything. There’s nothing there” (2016...

Observations on Working Psychoanalytically with a Profoundly Amnesic Patient.

Individuals with profound amnesia are markedly impaired in explicitly recalling new episodic events, but appear to preserve the capacity to use information from other sources. Amongst these preserved capacities is the ability to form new memories of an emotional nature – a skill at the heart of developing and sustaining interpersonal relationships. The psychoanalytic study of individuals with profound amnesia might contribute to the understanding the importance of each memory system, including effects on key analytic processes such as transference and countertransference. However, psychoanalytic work in the presence of profound amnesia might also require important technical modifications. In the first report of its kind, we describe observations from a long term psychoanalytic process (72 sessions) with an individual (JL) who has profound amnesia after an anoxic episode. The nature of therapy was shaped by JL’s impairment in connecting elements that belong to distant (and even relatively close) moments in the therapeutic process. However, we were also able to document areas of preservation, in what appears to be a functioning therapeutic alliance. As regards transference, the relationship between JL and his analyst can be viewed as the evolution of a narcissistic transference, and case material is provided that maps this into three phases: (i) rejecting; (ii) starting to take in; and (iii) full use of the analytic space – where each phase exhibits differing degrees of permeability between JL and the analyst. This investigation appears to have important theoretical implications for psychoanalytic practice, and for psychotherapy in general – and not only with regard to brain injured populations. We especially note that it raises questions concerning the mechanism of therapeutic action in psychoanalysis and psychotherapy, and the apparent unimportance of episodic memory for many elements of therapeutic change.

Living Truthfully Under Imaginary Circumstances: Improvisation in Psychoanalysis

Improvisation in psychoanalysis has heretofore been defined by a theater games model in which the emphasis is on a creative exchange of dialogue. That dialogue focuses on maintaining an established story line. In this paper, I expand the concept of improvisation by drawing on the contributions of Sanford Meisner. In his model, two improvisers through mutual influence maintain affective engagement. Dialogue emerges unpredictably out of that affective engagement and facilitates it. Meisner described this process as “living truthfully under imaginary circumstances.” Clinical case material illustrates how a Meisner improvisation can be applied to circumstances in which the analyst is pushed beyond familiar analytic comfort zones. Such an improvisation provides the analyst with an additional resource with which to respond to these challenging moments in ways that facilitate increasing intimacy between patient and analyst. I spell out how a Meisner improvisation impacts therapeutic action in psychoanalysis.

Repressed Ghosts and Dissociated Vampires in the Enacted Dimension of Psychoanalytic Treatment

One of the most evocative uses of the metaphor of a ghost in psychoanalytic writing was crafted by Hans Loewald in “On the Therapeutic Action of Psycho-Analysis” (1960). In this seminal work, Loewald likened the process of psychoanalytic change to that of transforming psychic ghosts into ancestors. In the present paper, the author supplements the metaphor of ghosts that haunt with the metaphor of vampires that menace, and links these two alien experiences to two psychological processes: repression and dissociation. Descriptions of ghosts and vampires in folklore, and the ways they are experienced in analytic treatment, are followed by an explication of the enacted dimension of analytic process—the arena of treatment in which all demons are inevitably revivified, “recognized,” and ultimately laid to rest. The paper includes a clinical illustration of a dissociated vampire: a Holocaust trauma transmitted across three generations of survivors.

Hans Loewald’s “On the therapeutic action of psychoanalysis”: Initial reception and later influence.

Hans Loewald’s “On the therapeutic action of psychoanalysis”: Initial reception and later influence.

Charles Rycroft and the Making of an Independent Psychoanalyst

This article explores the work of Charles Rycroft and the potential reasons why it has been unjustly—in the author's opinion—consigned to an obscure corner of the history of psychoanalysis and contemporary psychoanalysis. In the first section, the author traces the origins of the Independent group in Great Britain to which Rycroft belonged. The second section outlines the key stages in Rycroft's private and professional life to provide insight into his development as an Independent psychoanalyst. The final section highlights one of the key ideas that Rycroft bequeathed to us: namely, his theory of the therapeutic action of psychoanalysis.

Fields of Thought and Action in Psychoanalysis: Commentary on Paper by Donnel B. Stern

In this discussion of Donnel B. Stern's (this issue) paper “Field Theory in Psychoanalysis, Part 2: Bionian Field Theory and Contemporary Interpersonal/Relational Psychoanalysis,” I detail Nietzsche's influence on shaping contemporary accounts of the field. The discussion then takes up the differences between how the two schools of thought conceptualize the therapeutic action of psychoanalysis. Finally I offer a story from when Ferro and I met and exchanged clinical vignettes. These vignettes give another view of the overlap and difference between the two approaches.

On traumatic and therapeutic factors in communication: From Sándor Ferenczi to Charles Rycroft

Discussing Charles Rycroft's seminal paper “The nature and function of the analyst's communication to the patient,” presented in 1956 at the Freud Centenary, the author reflects on Rycroft's theory of what constitutes a healthy and a pathological communication and of the therapeutic action of psychoanalysis, linking it with Sándor Ferenczi's theory of trauma.

Credo

If I were asked to reduce my “Credo” to two sentences they might be the following: I believe that what we call the therapeutic action of psychoanalysis is a self/other negotiation that takes place between and within analyst and patient at the interface of dissociation and the capacity to hold internal conflict. It is a nonlinear process that endows both their relationship and their individual self-states with an ever-evolving experience of wholeness that is the primary source of healing and growth.

The therapeutic action of psychoanalysis

Psychoanalysis does not seek to get rid of symptoms but to question them as witnesses of psychic functioning and as formations of the unconscious. Whatever their nature may be, it is a question of analysing their causes and their functions as they appear and develop during the course of the analytic process. The latter is activated by the transference relationship induced by the method within a specific setting. The aim is to bring about liberating psychic transformations. The extension of the indications and modifications in the expression of psychic suffering have led to the development of psychotherapies. Their relations with psychoanalysis proper have been evolving constantly since the first advances by Ferenczi. This long historical evolution has resulted in their redefinition. Psychoanalytic practices are currently considered to require, depending on the case, different settings and different modes of psychic involvement from the analyst. Contemporary psychoanalysis places emphasis on the internal setting of the analyst (thus his training), analysis of the countertransference, and the risk of anti‐analytic aberrations.

Worlds of Devastation: A Phenomenologist's Comments on “Therapeutic Action in Psychoanalysis”

Worlds of Devastation: A Phenomenologist's Comments on “Therapeutic Action in Psychoanalysis”

Creating New Ways of Being and Relating

The therapeutic action of psychoanalysis has been broadened beyond interpretation to the creation of new ways of being and relating. The concept of analysis as including both understanding and creation is rooted in two major analytic traditions: the British Independent school and the relational movement. It is proposed that central concepts from each tradition can be combined to form a theory of technique that is focused creating new ways of being to replace the patient's historical patterns. The clinical strategy advocated here is aimed toward bringing dissociated self states to consciousness and then using the now conscious conflicting states to create new self-world relationship patterns. A theory of technique is suggested that combines the relational concepts of dissociated patterns of interaction with Winnicott's theory of potential space for the purpose of transforming latent psychic capacities into new forms of being. Specific criteria are proposed for identifying new potentially authentic ways of being, and a technique for facilitating their evolution from nascent dispositions to new ways of being is delineated. Two cases are used to illustrate how the technical strategy can be used to create ways of being from previously dormant psychic potential.

Minding the Dissociative Gap

I offer the view that the source of therapeutic action in psychoanalysis is a shared minding of the dissociative gap—a process that simultaneously decreases the mind's fear of otherness and the vulnerability of the brain's neural networks to potential affect dysregulation. Through a patient's “me” and “not-me” self-states becoming more at home with each other, the automatic neurosynaptic warning signal that triggers immediate dissociation as a protection against potential hyperarousal becomes more selective at the brain level and, through a feedback loop, allows the patient's mind to support increased development of intersubjectivity. Little by little, the patient's capacity to bear internal conflict is increased by easing the mental struggle to hold it cognitively. For a classical psychoanalyst, taking this seriously does not lead to abandoning Freud, but it does lead to a different listening stance. It requires listening to clinical process not only dyadically, but listening to it as an inherently confusing affective event to be processed together, rather than as content to be “understood”; that is, organized by the analyst into something he deems cognitively conceptual and then made available for potential interpretation. Clinical examples are provided for consideration.

Preserving the Gap between Freudian and Relational Psychoanalysis

Relational psychoanalysis represents the composite of contributions from a variety of psychoanalysts, all of whom found dissatisfaction in their clinical work with patients where the restrictions of the classical psychoanalytic approach led to unsatisfactory or less than optimal outcomes with their patients. While some have emphasized the technical limitations of classical psychoanalysis, others have rejected the classical theory of causality and the central role of insight and interpretation. Whether on the basis of technical or theoretical differences, relational psychoanalysts have placed greater emphasis on the role of the relationship between analyst and patient in accounting for the therapeutic action of psychoanalysis. What has evolved is distinctly different from, indeed, oppositional to, classical psychoanalysis. Therefore, the attempt to homogenize relational and classical approaches risks the possibility of obscuring the significant differences between them. If such a homogenization occurs, psychoanalysis loses the status of a clinical discipline that must stay open to changes in practice that reflect the experience of those who employ it in their clinical work.