Tuesday, August 30, 2011

Judith Mitrani on Psychosomatic Conditions and Unmentalized Experience

"It might be concluded that certain unmentalized experiences in early object relations play a pivotal role in the emotional etiology of psychosomatic asthma in some patients. The selection or choice of the asthmatic symptom, as an expression of a deficient environment or as a sign of developmental arrest, is determined (as concerns the psychic component) by the unconscious phantasies, conflicts, wishes and fears of the primary object(s) which impinge upon the infant (and perhaps even the foetus) in the early, formative stages of development.

The concept of a psychosomatic aspect of the personality, rather than a psychosomatic personality or a psychosomatic patient may prove to be of some merit. Likewise, it may be worthwhile to consider a deficient area of alpha—function (or a circumscribed or limited deficiency in the holding and containing function of the primary object) with respect to a particular (rather than a general) vulnerability in the infant. This "coincidence of vulnerability" in both infant and the primary caretaker may be seen to have unfortunate consequences in terms of the subsequent development of mental structure.

Until recently, traditional psychoanalytic approaches to the treatment of psychosomatic asthma have been aimed toward seeking out conflicts and phantasies within the mind which seem to exert their pathological effects upon the body. With the introduction of the notion of unmentalized experience, an approach is implied in which the analyst attempts to shift somato—sensory memories and proto—phantasies from the body into the mind, where they may be represented for the first time. The aim of psychoanalysis then is to build psychic structure; to further develop a mind—ego from an original body—ego.

The capacity of the analyst to assist the patient in transcending and transforming early environmental failures as well as innate deficiencies is an essential factor in facilitating the gradual relinquishment of asthma as a self-survival tactic. By presenting him or herself as a reliable, durable and flexible (although transitional) object and as a benign, reflective, and understanding presence, the analyst serves to repair and promote growth within the internal world of the patient."
(p. 338)


Mitrani, J.L. (1993). "Unmentalized" Experience in the Etiology and Treatment of Psychosomatic Asthma. Contemporary Psychoanalysis, Vol. 29 pp. 314-342.

Friday, August 26, 2011

C.G. Jung on Archetypes and the Collective Unconscious

"Just as we have been compelled to postulate the concept of an instinct determining or regulating our conscious actions, so, in order to account for the uniformity and regularity of our perceptions, we must have recourse to the correlated concept of a factor determining the mode of apprehension. It is this factor which I call the archetype or primordial image. The primordial image might suitably be described as the instinct's perception of itself, or as the self-portrait of the instinct, in exactly the same way as consciousness is an inward perception of the objective life process. Just as conscious apprehension gives our actions form and direction, so unconscious apprehension through the archetype determines the form and direction of the instinct. . .

Archetypes are typical modes of apprehension, and wherever we meet with uniform and regularly recurring modes of apprehension we are dealing with an archetype, no matter whether its mythological character is recognized or not.

The collective unconscious consists of the sum of the instincts and their correlates, the archetypes. Just as everybody possesses instincts, so he also possesses a stock of archetypal images." (pp. 136-138)

C.G. Jung (1919). Instinct and the Unconscious. The Collected Works of C.G. Jung, Vol. 8., pp. 129-138.

Tuesday, August 23, 2011

Robert Stolorow Makes the Case for a Broad Definition of Intersubjectivity

"An important development in the contemporary move from Cartesian isolated-mind thinking in psychoanalysis toward a post-Cartesian contextualism that recognizes the constitutive role of relatedness in the making of all experience has been the theoretical and clinical focus on the concept of intersubjectivity. Recent psychoanalytic discourse on intersubjectivity, however, has been clouded and befuddled by the intermixing and confounding of different uses of the term intersubjective that have distinctly different meanings at different levels of abstraction and generality (Stolorow, Orange, & Atwood, 2001a). Developmentalists such as Stern (1985) have used the term intersubjective relatedness to refer to the developmental capacity to recognize another person as a separate subject. In a similar vein, Benjamin (1995), drawing on Hegel's (1807) idea that self-consciousness is achieved through the reflection of one's consciousness in the consciousness of another, has defined intersubjectivity as mutual recognition. Ogden (1994), by contrast, seems to have equated intersubjectivity with what for me is only one of its dimensions, a domain of shared experience that is prereflective and largely bodily, what I prefer to call unconscious nonverbal affective communication. For my collaborators and me, intersubjectivity has a meaning that is much more general and inclusive, referring to the relational contexts in which all experience, at whatever developmental level—linguistic or prelinguistic, shared or solitary takes form (Stolorow & Atwood, 1992). For us, an intersubjective field—any system constituted by interacting experiential worlds—is neither a mode of experiencing nor a sharing of experience. It is the contextual precondition for having any experience at all (Orange, Atwood, & Stolorow, 1997). Our intersubjective perspective is a phenomenological field theory or dynamic systems theory that seeks to illuminate interweaving worlds of experience. Experiential worlds and intersubjective fields are seen as equiprimordial, mutually constituting one another in circular fashion.

The central metaphor of our intersubjective perspective is the larger relational system or field in which psychological phenomena crystallize and in which experience is continually and mutually shaped. Our vocabulary is one of interacting subjectivities, reciprocal mutual influence, colliding organizing principles, conjunctions and disjunctions, attunements and malattunements—a lexicon attempting to capture the endlessly shifting, constitutive intersubjective context of emotional experiencing, both in the psychoanalytic situation and in the course of psychological development. From this perspective, the observer and his or her language are grasped as intrinsic to the observed, and the impact of the analyst and his or her organizing activity on the unfolding of the therapeutic relationship itself becomes a focus of analytic investigation and reflection.

Intersubjective systems theory seeks to comprehend psychological phenomena not as products of isolated intrapsychic mechanisms, but as forming at the interface of reciprocally interacting worlds of experience. Psychological phenomena, we have repeatedly emphasized, "cannot be understood apart from the intersubjective contexts in which they take form" (Atwood & Stolorow, 1984, p. 64). Intrapsychic determinism thus gives way to an unremitting intersubjective contextualism. It is not the isolated individual mind, we have argued, but the larger system created by the mutual interplay between the subjective worlds of patient and analyst, or of child and caregiver, that constitutes the proper domain of psychoanalytic inquiry. Indeed, as we have shown, the concept of an individual mind or psyche is itself a psychological product crystallizing from within intersubjective fields and serving specific psychological purposes (Stolorow & Atwood, 1992)."  (pp.. 329-330)

Stolorow, R.D. (2002). Impasse, Affectivity, and Intersubjective Systems. Psychoanalytic Review, Vol. 89, pp. 329-337

Friday, August 19, 2011

James Hillman on Soul

"By soul I mean, first of all, a perspective rather than a substance, a viewpoint toward things rather than a thing itself. This perspective is reflective; it mediates events and makes differences between ourselves and everything that happens. Between us and events, between the doer and the deed, there is a reflective moment -- and soul-making means differentiating this middle ground.

It is as if consciousness rests upon a self-sustaining and imagining substrate -- an inner place or deeper person or ongoing presence -- that is simply there even when all our subjectivity, ego, and consciousness go into eclipse. Soul appears as a factor independent of the events in which we are immersed. Though I cannot identify soul with anything else, I also can never grasp it apart from other things, perhaps because it is like a reflection in a flowing mirror, or like the moon which mediates only borrowed light. But just this peculiar and paradoxical intervening variable gives on the sense of having or being soul. However intangible and indefinable it is, soul carries highest importance in hierarchies of human values, frequently being identified with the principle of life and even of divinity.

In another attempt upon the idea of soul I suggest that the word refers to that unknown component which makes meaning possible, turns events into experiences, is communicated in love, and has a religious concern. These four qualifications I had already put forth some years ago. I had begun to use the term freely, usually interchangeably with psyche (from Greek) and anima (from Latin). Now I am adding three necessary modifications. First, soul refers to the deepening of events into experiences; second, the significance of soul makes possible, whether in love or in religious concern, derives from its special relation with death. And third, by soul I mean the imaginative possibility in our natures, the experiencing through reflective speculation, dream, image, fantasy -- that mode which recognizes all realities as primarily symbolic or metaphorical." (p. X)

James Hillman (1975). Revisioning Psychology. New York: Harper & Row.

Tuesday, August 16, 2011

Stefano Bolognini on the Interaction of the Intrapsychic and the Interpsychic

"The ‘interpsychic’ is an extended psychic dimension, regarding the joint functioning and reciprocal influences of two minds. The concepts of ‘subjectivity’ and ‘person’ can be included in the ‘interpsychic’. They can also overlap with each other, and sometimes all three can overlap together, but they do not necessarily coincide. In the different contemporary perspectives, how can we modify the intrapsychic ‘through’ (and ‘with’ and ‘by’) the interpsychic? . . .

It is the ambition of all psychoanalysts to be able to change, to some extent, certain aspects of the patient's intrapsychic life lastingly and structurally. Every school has its specific goals for the change process, depending on its theoretical assumptions, but all agree that the patient should terminate analysis (though not self-analysis, a ‘never ending’ contact with the introjected analytical function) once crucial and lasting changes within him have come about.

There are, in fact, no real differences of opinion on the next step either, that is on the general principle that the patient's intrapsychic changes are also the result of work on the patient's intrapsychic with that same patient's intrapsychic (development of transference, stream of associations, re-emergence of memories, insight and so on) and with the analyst's intrapsychic (analysis of his own transference and countertransference, the use of his associations, memories and so on to formulate interpretations).

All analysts agree with these propositions in what I might call an ‘unsaturated’ way, in that they by no means exclude these passages from their analytic work. Likewise, everyone maintains, speaking in general terms, that there is inevitably interaction between analyst and patient (without being ‘interactivists’ by this admission), just as there is between mother and child, and that the intra- and intersubjective dimensions cannot be separated during treatment, though there may be oscillation, with one occasionally predominating over the other (Green, 2000).

Differences arise when it comes to discussing how and how much this interaction comes about, in what direction and with what effects, with what advantages or what risks, and what its technical use is, given the complexity of the conscious, unconscious and preconscious levels involved. To sum up, the question is: what importance should we give to the work of the intrapsychic through the interpsychic in bringing about changes?

It is at this point that we have a branching out of innumerable personalised viewpoints. After a detailed examination of recent literature on the subject, I suspect there may be as many different viewpoints as there are psychoanalysts. . . .

It must also be pointed out that the different theoretical-clinical positions, correlating to the different training and the subjective nature of each analyst, nevertheless correspond (more or less consciously) to different concepts of the mind. The idea of a psychic apparatus predominantly overdetermined by internal drives and phantasies, as in classical Freudian and Kleinian thinking, or, conversely, much more capable of being modulated in its functioning in connection to relational developments, as in subsequent thinking of the followers of Winnicott, Bion, Kohut or the intersubjectivists (though so very different among themselves), then generated a remarkable variety of technical systems, and consequently different investments on the intra- and interpsychic sides. . . .

Along the axis which links, but also separates, the two positions, we find the supporters of the ‘intra-’ and ‘interpsychic’. I want to make it clear right from the start that I am not going to deal with the caricatures proposed by each of the opposite extremes to describe the other, because I feel they are unrealistic and biased. For too long we have been swamped with improbable depictions of the ‘mirror-like analyst’ dehumanised and impersonal, an awesome cleric or functionary of a superhuman entity called psychoanalysis, with a splitting between ‘supposed knowledge’ and supposed existence, ‘passed through by the discourse of the unconscious’ inflexibly ‘Other’ with respect to the patient but also going by these descriptionswith respect to himself and human society, ‘pure analysing function’ and so forth; the analyst ‘non-persona’ who ‘non per-sonat’ (i.e. is unable to perceive and use his own internal resonance in his patient's communications (Lopez, 1983)), and cannot partially or temporarily feel for the characters (‘personae’) in the internal world of others without necessarily identifying himself with them; he who takes the ideal to be hoped for in certain cases of knowing how to be ‘personne’ (‘no one’ like Ulysses (Sechaud, 2003)) to extremes when the analytic work requires or allows it.

This legendary type of analyst, faithful to the ‘myth of the isolated mind’ (Stolorow and Atwood, 1992) is a myth in itself, perhaps required to configure ‘strong’ differentiation and counterpositions; but it is really an improbable construction, the stuff of films.

At the other extreme, I received no less disquieting descriptions of ‘horizontal’ analysts, a-generational, heedless of the past, of the unconscious, of transference, of their patients's individuality and sexuality, projected into the ‘here and now’ of the actual situation, corrective, transgressive and hyper-symmetrical. . . .

Having rid ourselves of these caricatures, I will attempt to describe what one really finds along the axis that links the two poles. I hope to be respectfully perceptive towards the two orientations I will present, although theoretical developments are currently moving towards a growing appreciation of the interpsychic. We should bear in mind Aron's (1996) observation that, in many cases, both options are at the service of resistance.1

Above all, we should note a trend towards integration (leading to a broadening and greater extension of the theoretical view). Thus, while recognising the richness of analytic exchange, many analysts believe it absolutely necessary to refer to both the intrapsychic model and the bi-personal one, two dimensions which are in dialectic equilibrium during analysis and even within the session itself (Ponsi and Filippini, 1996; Rocchi, 1997; Grispini, 2000)."  (pp. 337-339)
Stefano Bolognini (2004). Intrapsychic - Interpsychic, International Journal of Psycho-Analysis, Vol. 85, pp. 337-358

Friday, August 12, 2011

Jess Groesbeck on Cure and the Wounded Healer

"Finally, we must return to the question, what is at the heart of the healing mystery? As described earlier in the myth of Asclepius, being raised by Chiron ‘the primordial science of the wounded healer is nothing more than a knowledge of an incurable wound in which the healer forever partakes’. In attempting to answer these questions, we asked: Why, for the cure to take place, does the healer himself have to have knowledge of his own wounds and actually participate in them, again and again? As we have tried to show through a detailed account of the transference that occurs in the analytic process and other therapeutic relationships, it is only when the healer himself can stay in touch with and experience his own wounds and illnesses as well as confront the powerful images from the unconscious of an archetypal nature, that in turn the patient can go through the same process. For if indeed, true healing occurs, it would appear that, at least in one form, the wounded physician himself must accomplish it; but the analyst must assist. Jung said it in another way (JUNG 14, p. 116): ‘No analysis is capable of banishing all unconsciousness forever. The analyst must go on learning endlessly, and never forget that each new case brings new problems to light and thus gives rise to unconscious assumptions that have never before been constellated. We could say, without too much exaggeration, that a good half of every treatment that probes at all deeply consists in the doctor's examining himself, for only what he can put right in himself can he hope to put right in the patient. It is no less, either, if he feels that the patient is hitting him, or even scoring off him: it is his own hurt that gives the measure of his power to heal. This, and nothing else, is the meaning of the Greek myth of the wounded physician.’

Adler also states the purpose of facing our wounds may be in essence the way to find those healing powers within us (ADLER 1). Possibly this is the motive that attracts people to the healing profession. Like the proverbial fools, they enter in where angels fear to tread. One analyst recently told the author that he would never quit practising and seeing patients because if he did he would get sick again. In substance he is saying that it is only through his own exposure in analytical work with patients that he is able to stay in touch with himself and find the roots and sources of wholeness to the degree that he can stay in some kind of balance.

Though healing ultimately is a mystery, trying to fathom it is a never-ending exciting venture; for in our quest we may come to know something more of ourselves."
(pp. 143-144)

C. Jess Groesbeck (1975). The Archetypal Image of the Wounded Healer. Journal of Analytical Psychology, Vol. 20, pp. 122-145


Thursday, August 11, 2011

Publication Announcement from The Psychoanalytic Muse

My book Deep Blues: Human Soundscapes for the Archetypal Journey is now available for purchase in both paperback and e-book editions at Amazon, Barnes & Noble, and The Fisher King Review.  Deep Blues explores the archetypal journey of the human psyche through an examination of the blues as a musical genre. The genesis, history, and thematic patterns of the blues are examined from an archetypal perspective and various analytic theories – especially the interaction between Erich Neumann’s concept of unitary reality and the blues experience. Mythological and shamanistic parallels are used to provide a deeper understanding of the role of the bluesman, the blues performance, and the innate healing potential of the music. Universal aspects of human experience and transcendence are revealed through the creative medium of the blues. 
"Just like a fine bluesman, Winborn ‘riffs’ on the various psychological aspects of his topic: the genesis of the sound, the unitary reality created in playing and listening to the blues, its archetypal manifestations and healing potential, and the influence of the personality of performer and performance. As he states, ‘the blues belongs among the great arts because of its extraordinary capacity to embrace, embody, and transcend the opposites, especially as they become manifest in the experience of tragedy and suffering.’ Using original lyrics throughout, Winborn invites us to reimagine the power of the blues in its ability to deepen our own soulfulness." —August J. Cwik, Psy.D., Jungian Analyst & Musician

Tuesday, August 9, 2011

Raphaël Enthoven On Reverie

In a brief deviation from psychoanalytic authors, I have elected to include a thoughtful and poetic exposition of reverie by French philosopher Raphaël Enthoven who teaches at École Polytechnique and Sciences Po in Paris. While not specifically addressing the psychoanalytic notion of the analyst's reverie - I believe it has something to offer the analytic reader in terms of moving into states of reverie:

'Reverie is contemplation from within, letting the person who gives way to it feel change. Born of the desire and not the need to be directly involved in our surroundings, reverie strips the world of its utility. It borrows the power of narration from wakefulness and the power of divination from sleep, and keeps them vying to suspend the alternation of day and night. Reverie is how one arrives at immediacy.

Between the sweetness of being and the pain of thinking, between sleep that is opaque to itself and the blindness of one who can’t see the stars because of daylight, lies the talent to glimpse what escapes us, the equivalent of the dawn that threatens at every instant to evaporate into dream or condense into knowing, but in that interval (and pen in hand) replaces something impenetrable with something immaterial and reveals the imaginary foundations of reality. Reverie never rests.

"Thought," Bachelard says, "is reverie brought to a center. Reverie is thought turned loose." One of the lessons of reverie is that you have to sleep with your eyes open occasionally so that knowledge can find the path hearts take. For reverie is not an artifice of hidden meaning but, instead, works to squeeze every last drop from appearances. Its grail is not truth but the merging of types . . .

Because it generously accords the world the absentmindedness it deserves, reverie is light years distant from being a distraction, which does reality the considerable honor of turning its back on it. In fact, reverie celebrates the rediscovery of understanding and imagination, sets free the secret of disinterest which, because it lets you see beauty without your consent and see nature without ego, invests the world with intense interest.'

This excerpt was extracted from The New York Times online edition on April 6, 2001.  (http://opinionator.blogs.nytimes.com/2011/08/06/on-reverie/?hp)

Saturday, August 6, 2011

Linda Carter on the Transcendent Function and Emergence Theory

"I will consider the transcendent function as a central therapeutic process which has the potential to effect change in analysis. This central concept was first described in 1916 by Jung as an intrapsychic phenomenon although one can feel its presence in what many would see as the intersubjective matrix of ‘The psychology of the transference’. In reading the work of Beebe (2002), Sander (Amadei & Bianchi 2008), Tronick (2007) and Stern and the Boston Change Process Study Group (1998), resonances to the transcendent function can be registered but these researchers seem to be more focused on the interpersonal domain. In particular Tronick’s concept of ‘dyadic expansion of consciousness’ and ‘moments of meeting’ from the Boston Change Process Study Group describe external dyadic interactions between mothers and babies and therapists and patients. In contrast, Jung’s early focus was on the intrapsychic process of internal interaction between the conscious and the unconscious within an individual. From an overall perspective, the interpersonal process of change described by infant researchers, when held in conjunction with Jung’s internal process of change, together form an overarching whole in which the dyad may be viewed as part of a complex adaptive system whose emergent properties include a transformation of individual consciousness via dyadic interactions.

Emergence is a current concept that we can read backward into Jung’s work on the transcendent function. It could be said that it is through the dynamic interaction of lower level elements in a scale free network2 that a supraordinate self emerges and transcends its antecedents. The whole is greater than the sum of its parts, as is the case with the mind emerging from the body, brain and environment. This notion has highly significant implications for analysis, science and theology, among many other fields. From Beebe’s point of view, emergence is the engine of change that results from the integration of the mutual co-ordination of parts within an interactive, co-created system (personal communication, May 2009).

Jung’s notions of the transcendent function are in many ways harmonious with a systems perspective. First, there is a conjunction of opposites. Then the complementary/compensatory nature of the unconscious in relation to onesided consciousness leads to emergence of the symbol. And finally, a new and complex entity, a synthesis not a fusion of antecedents, is presented. The result is a transformed attitude and the birth of a sense of wholeness.

According to Jung (1916/1960, para. 146), ‘the suitably trained analyst mediates the transcendent function for the patient, i.e., helps him bring conscious and unconscious together and so arrive at a new attitude’. In addition, Jung’s oft quoted lines analogizing the analyst/patient relationship with chemical interaction and mutual transformation resonates with contemporary views of both self and mutual regulation within an interactive field. As I see it, the emergence of the transcendent function is highly dependent on the reflective function of the individuals and the dyad within a co-constructed field. Indeed, the analyst’s successful history of experiences with the transcendent function, grounded in healthy interactive relationships, provides a holding environment for the emergence of evermore complex systems intrapsychically and with outer others. One could say that this view offers an understanding of the mechanics of containment which differs from Bion’s notion of projective identification. There is a move here toward mutual influence which fits well with Jung’s diagram of conscious/unconscious connections between the king and queen in ‘The psychology of the transference’. It should be noted, however, that analytic bidirectional influence is asymmetric and that if reflective function in the patient is limited, then the analyst carries symbolic understanding for the dyad while the patient’s abilities in this area are in the process of emerging. The symbolic attitude and reverie of the analyst provides a nutritive environment for the development of the patient’s ability to think and imagine about himself and interactions with others (see Bovensiepen 2002, p. 253)
(pp. 218-219)

Linda Carter (2010). The transcendent function, moments of meeting and dyadic consciousness: constructive and destructive co-creation in the analytic dyad. J. of Analytical Psychology, Vol 55, pp. 217-227.

Tuesday, August 2, 2011

Alan Sugarman on the Therapeutic Action of Mentalization

"Clarifying that we help our patients change by promoting a process of insightfulness has the potential to reduce the unfortunate tendency to artificially separate interpretation from the relationship with the analyst as the mutative factor in the psychoanalytic process. Central to this technical approach is the importance of attending to the formal organization of patients' minds, as key mental structures and modes of mental functioning are manifested in the interaction between patient and analyst. This emphasis on facilitating a process of insightfulness, with its goal of helping patients achieve and maintain a stable ability to mentalize, wherein key mental functions, not just contents, are subjected to self-reflection and affectivecognitive self-knowledge, reverses figure and ground and the traditional emphasis on knowing just unconscious mental content.

This approach is based on the idea that‘mentalization accounts for a continual, never-ending transformation of psychic contents through the multiplication and organization of representations. This permits the emergence of mental contents and structures of increasingly higher levels of complexity, leading to symbolization and abstraction’ (Lecours and Bouchard, 1997, p. 857). Our technical challenge becomes how to promote this process. Most patients show either circumscribed inhibitions of this process or a failure to have attained advanced modes because of early developmental interferences. A variety of benefits accrue from patients gaining insightfulness at an abstract-symbolic level of functioning (Bram and Gabbard, 2001). Self-other boundaries are strengthened as patients gain a cognitive-affective awareness that they have differentiated and conflicted minds that affect their behavior, and that others do also. Empathy improves with the realization that others' minds may be organized and function in different ways, or contain different feelings and beliefs. Interpersonal interactions are more easily understood and navigated by patients who can mentalize symbolically. Relationships feel safer as patients come to realize that others' actions are dictated by their mental functioning. Reality testing is facilitated, separation-individuation is promoted, and the primacy of secondary-process thinking is enhanced by symbolic mentalization. Finally, affect regulation is improved so that emotions can serve a signal function and not be experienced as overwhelming.

Promoting insightfulness improves self-regulation because patients' minds are better able to maintain homeostatic equilibrium as both their functions and contents become subject to conscious self-reflection and symbolic processing. Thus, patients' sense of self-as-agent are expanded. It should be noted that the role of the past has not been mentioned in this discussion of insightfulness. That is because this perspective does not emphasize the recovery of memories of the past as a crucial element in mutative action. Epistemological questions can be raised regarding whether it is even possible to do this with ‘memories’ of the past. Regardless, learning to mentalize symbolically seems most easily accomplished in the interactional field (Aron, 1996; Levenson, 1972; White, 1996) as patients transfer the organization and contents of their minds into it. Certainly memories from the past usually emerge as patients gain greater access to the workings of their minds. But this is a by-product of good analytic work, it is not essential to structural change. Some patients do need us to help them to understand regressions to or fixations at action modes of experiencing and communicating in terms of their pasts. These explanations are often necessary because patients can feel such shame or anxiety about their actions being seen and put into words. Their shame or anxiety needs to be assuaged before they can reflect more abstractly on the action. Some would argue that such shame or anxiety should be explored verbally instead of bypassed, i.e. Paul Gray (1994). In theory, this approach would be optimal. But some patients' shame or anxiety is experienced at such a concrete, action level that similarly concrete interventions may be necessary. Thus, the point of the genetic reconstructions that are sometimes necessary is not to help patients change by becoming aware of previously repressed mental content. Instead, it is a nonverbal confrontation that shame and/or anxiety are not necessary because their actions are understandable and containable. Hence, the impact lies with the analyst's nonverbal communication, not the content of his reconstruction, except insofar as the content is necessary to catch our patients' attention. Once again, technical interventions are guided by the dictate to promote symbolic insightfulness. This requires greater openness to ways of intervening with patients and deeper thinking into the impact of our interventions. So long as we maintain a commitment to freeing up our patients' mental processes, the more likely we are to transform and liberate their symbolic capacities (Friedman, 2002)." (pp. 980-982)

Alan Sugarman (2006). Mentalization, Insightfulness, and Therapeutic Action: The Importance of Mental Organiation. International Journal of Psycho-Analysis, Vol. 87, pp. 965-987.