Wednesday, December 26, 2012

Cortina and Liotti - The Relationships between Attachment and Intersubjectivity

Abstract: The relationships between intersubjectivity and attachment are beginning to be explored within the psychoanalytic and developmental literature. We contribute to this comparative effort by exploring the different evolutionary origins of attachment and intersubjectivity. Five interlocking themes are central to this article. First, from an evolutionary perspective, attachment and intersubjectivity serve different functions. The main function of attachment is to seek protection, whereas the main function of intersubjectivity is to communicate, at intuitive and automatic levels, with members of the same species and to facilitate social understanding. Second, to survive in changing and highly competitive environments, an evolutionary strategy emerged among our human ancestors based on developing high levels of cooperation within small bands of hunters and gatherers. In turn, high levels of cooperation and social complexity put selective pressures toward developing effective modes of communication and more complex forms of social understanding (mindreading/mentalizing/ intersubjective abilities). These abilities far surpass mindreading abilities among our closest Great Ape relatives. Third, we provide further evidence for this hypothesis showing that in comparison with other Great Apes, young children show qualitatively different levels of collaboration and altruism. Fourth, we provide an overview of the development of attachment and intersubjective abilities during the first 2 years of life that support the hypothesis of a cooperative origin of intersubjectivity. Fifth, we return to the main theme of this article showing three ways in which attachment and intersubjective abilities can be distinguished. We conclude by exploring some clinical implications of this cooperative–intersubjective model of human development.

Mauricio Cortina and Giovanni Liotti (2010) Attachment is about Safety and Protection, Intersubjectivity is about Sharing and Social Understanding: The Relationships between Attachment and Intersubjectivity. Psychoanalytic Psychology, Vol 27(4), pp. 410-441

Saturday, December 22, 2012

Michael Fordham - Ego as Deintegrate of the Self

"In a previous paper (Fordham, 1957a) to which the reader is referred for a fuller account of what follows, I quoted Jung in support of a theory that the self is the prototype of the ego; this, together with other considerations, led to the postulate of an original self, which differs from all other states of integration in that it has no subjective manifestations though it can be inferred or intuited by observation. The theory postulated an original self which cannot give rise to the ego without dividing up spontaneously into parts termed deintegrates; these, by forming the basis for images of the archetypes, make possible the gradual development of the infant's relation to his mother and himself, and the gradual establishment of the ego over against the archetypal energies. These can at first often be observed to threaten the infant, and would overwhelm him disastrously were he not cared for by his own mother, who takes responsibility for satisfying his needs and protecting him, on the one hand, from social pressures with which he is manifestly not ready to deal, on the other from the complex inner energies against which he can be equally helpless and against whose effect even the best mothers are sometimes powerless.

The relation of the ego to the archetypes in infancy is radically different from that in later years; originally the ego is assumed to grow out of the self, as the result of its spontaneous deintegration followed by its reintegration. This process repeats, so that the self, considered dynamically, integrates and deintegrates in a rhythmic sequence. Gradually ego boundaries form and the psyche gains a demonstrable structure; only then can we refer to the complementary opposites, the ego and the archetypes, which can express themselves in images. It is recognized that, once this has happened, the energy in the archetypal forms bears a compensating relation to the strength of the ego as the centre of the conscious mind, and so, as the relative dominance of the ego comes about, the archetypal forms sink into the background or get hidden behind the barriers of repression. But when, as happens later in life, the ego ceases to have the same significance, as Jung has convincingly shown, it becomes drained of part of its energy and archetypal activity increases until finally the ego is displaced. It follows that the individuation process begins when ego consciousness, as an ideal and as a social and personal necessity, collapses.

The essential problem lies in the relation of the ego to the self; in early ego development the self is conceived to give rise to the ego, which then takes up its own struggle to extend consciousness with the support of, or in opposition to, the self. In individuation the self starts by performing the opposite function; it so to say attacks and eliminates the ego's position of pre-eminence which, as an illusion, it never regains."
(pp. 123-124)

"The thesis of this paper is mainly conservative inasmuch as it contests the extension of the classical concept of individuation to embrace the first half of life, including infancy. If individuation be defined as realization by the ego of the tendency to wholeness, it cannot cover the predominantly splitting processes of early infancy and childhood which lead to the opposition ego—unconscious. In the second half of life there may be deintegration of the self, but the predominating process is a uniting one; it leads to awareness of the ego as part of a greater whole, the self....In infancy the ego and self are not separate from each other in the way which Jung has correctly emphasized for personalities in whom the ego is a sufficiently organized structure. In them the ego can be distinguished clearly from that larger integer the self, and when this happens the process of individuation becomes an empirical fact." (pp. 127-128)


Michael Fordham (1958). Individuation and Ego Development. Journal of Analytical Psychology, Vol. 3, pp. 115-130

Sunday, December 16, 2012

Guiseppe Civitarese - Immersion vs. Interactivity

"....any analytic style or model that aims to produce a transformative experience must satisfactorily resolve the conflict between immersion (the analyst's emotional participation and sticking to the dreamlike or fictional climate of the session, dreaming knowing it's a dream) and interactivity (for the most part, interpretation as an anti-immersive device that ‘wakes’ one from fiction and demystifies consciousness). In analytic field theory the setting can be defined — because of the weight given to performativity of language, to the sensory matrix of the transference and the transparency of the medium — the place where an ideal balance is sought between immersion and interaction." (p. 279)

Guiseppe Civitarese (2008). Immersion Versus Interactivity and Analytic Field. International Journal of Psycho-Analysis, Vol. 89, pp. 279-298

Wednesday, December 12, 2012

Norah Moore - The Transcendent Function and the Forming Ego

Editors Note: Jung's concept of the transcendent function and the corresponding production of symbols has similarities with Wilfred Bion's concept of the alpha function.   Bion conceptualized the alpha function as working on unmetabolized aspects of experience, referred to as beta elements, which are transformed,  via the alpha function, into aspects of experience which can be reflected on - metabolized experiences which he referred to as alpha elements.

"Jung's first exposition of this concept was in the paper ‘The transcendent function’ written in 1916 (JUNG 10), although he had prepared the way in an earlier description of the symbol as a means of assimilating the unconscious contents and as a bridge to ‘the best of man’ (JUNG 9). He speaks of the conscious and unconscious tendencies together making up the transcendent function: unconscious material is needed for it in conjunction with the ego which searches for meaning and strives to understand the unconscious; alternatively, creative formulation, elaborating the unconscious material, allows it to condense into motifs of creative fantasy; that is to say, into symbols. Understanding and creative formulation often go hand in hand, each regulating the other. In this process, he says, the ego takes the lead, but the counterposition in the unconscious is equal in value to it.

In ‘Definitions’, published in 1921, this description of the process of the transcendent function is elaborated in a way that stresses the experience which accompanies it, and the effect it has of causing a change of direction. The symbol is described there as the best possible expression of a fact which is relatively unknown at the moment of the symbol's birth, every psychic function going into its making. The full conscious confrontation of the opposites produces a violent disunion, and because the ego is forced at this moment to acknowledge both the rational and the irrational as equals, it cannot choose between them and a suspension of the will occurs, and this dams up vital energy. Out of this impasse, he says, a new unity is born, the symbol, which transcends the opposites, and stands in a compensatory relation to both, forming a middle ground where they are united, and which is acceptable to the ego. The symbolic nature of this new thing is recognizable by the accepting attitude of the conscious mind towards it, by the sense of revelation accompanying it and by the initiation of a reconstructive process with the setting up of new goals. Jung writes: ‘I have called this process in its totality the transcendent function’ (JUNG 12, p. 480).

In 1917 in ‘Two essays’, Jung again speaks of the transcendent function as the whole process, labour, action, and suffering of coming to terms with the unconscious (JUNG 11, p. 79). He then goes on to speak of its content and purpose: ‘It represents a function based on real and "imaginary", or rational and irrational, data, thus bridging the yawning gulf between conscious and unconscious.’ He says further (p. 108): ‘The transcendent function does not proceed without aim and purpose, but leads to the revelation of the essential man.… The meaning and purpose of the process is the realization, in all its aspects, of the personality originally hidden away in the embryonic germ-plasm; the production and unfolding of the original, potential wholeness.’

In 1940 in ‘The archetypes of the collective unconscious’, he says more about the way the birth of the symbol is reacted to. In the collision of opposites, he says, a third thing, the symbol, is born, which is of an irrational nature, and is neither expected nor understood and is at first rejected by both conscious and unconscious, but which leads to a new situation and promotes new conscious attitudes (JUNG 14).

This completed the description of the transcendent function, and elsewhere (JUNG 16, 13) the themes are repeated of the transcendent function as process and experience, without further elaboration.

Jung's viewpoint is that of the directed and formed minds of the adults he treated, for whom the unconscious material was not readily at hand (JUNG 10) but had to be sought in various ways. In addition to the transference as a source, he mentions dreams, fantasies and slips, and the practice of active imagination. He points out that in primitive people, in whom the mind is not yet directed, this search for unconscious material is unnecessary, since that is all around. He does not, however, describe how the transcendent function grows and is experienced by the forming ego as directedness comes to predominate over undirectedness in the course of civilization, or in the somewhat analogous development of a child.

I wish to explore those areas of the inception of the transcendent function. To Jung's formulation that every psychic function goes to the making of a symbol, I would like to add that only the psychic functions that have evolved enough at the time can participate. The real and imaginary data he mentions must be mediated by the senses, and by means of sense-perceptions of the outside world, while the archetypal images of the inner world must be encountered in bodily experience with the mother. The body bases of the symbol are found in the mode of bodily experience of the time, and in the kind of perception of the outside world of which the infant is capable."
(p. 164-165)


"It has been seen that the transcendent function shows itself at different developmental stages in different ways, but always acts in providing a stable basis for future growth by linking back to what has gone before, thus enabling the ego to make sense of new experience: at first by an emotionally charged symbolic equation which restores the original wholeness, and later by a representation which may also be strongly affective, when the ego is in a position to observe.

The transcendent function has its forerunner in the earliest months of life when the ego is forming, in the projection of archetypal images and in symbolic equivalence; it is formed of all the psychic functions and mechanisms and of the mode of perceiving of the time. It grows side by side with the ego in a mutual interaction, the body ego and observing ego developing together as islands of body experience which gradually become more continuous. The bridge between inner and outer is at first a symbolic equivalence, but representations of the lost primal self may then occur. As the ego develops it defends itself against the unconscious from which it is emerging, but also relates to it by participation in the transcendent function. Later on the formed ego is able to be an observer because defences have developed, and it has now to make some effort to get into touch with the unconscious, as in active imagination. While the ego is developing, or in times of regression, the unconscious is all around without much barrier, and no special effort need to be made to encounter it. The symbol forms a bridge for a two-way action between inner and outer, relating always to the wholeness of the self. The conscious mind reaches out to grasp whatever is unknown to it, whether in the unconscious or without, where the inner images are met as projections.

As at different stages there are different kinds of perception, there are also different mechanisms for communicating with the unconscious, and both these variables influence the way the transcendent function is experienced. At first there is a projective mechanism, which gives way later to creative formulation and imagination; the experience of the opposites is at first discontinuous, but later the opposites confront each other, and a capacity for ambivalence develops. The fixed attitude to the discontinuous inner world which is met in the archetypal transference gives place to the development of an as-if attitude to it which is more continuous.

At first wholeness is of a chaotic totality of experience, where real and imaginary data are not separated or distinguished; as the primal self deintegrates and islands of ego begin to form, the opposite aspects of the archetypes are projected separately in sequence, and encountered by the ego as outside phenomena, strange and unfamiliar, although they are inner images that are being met. The developing transcendent function forms a bridge between the opposites as they come into collision, and the gap between real and imaginary widens as the ego grows: here the symbol is born, which allows the conscious and unconscious to take hold of each other in a conjunctio at once tangible and infinite."
(pp. 179-180)

Norah Moore (1975). The Transcendent Function and the Forming Ego. Journal of Analytical Psychology, Vol. 20, pp.164-182

Wednesday, December 5, 2012

Louis Sander Passed Away November 28, 2012

Louis Sander - a member of the San Francisco Center for Psychoanalysis and the Boston Change Process Study Group - died at home on Wednesday, November 28, 2012 at the age of 94.  Below are the comments about Dr. Sander's contributions written by Stephen Seligman for Psychoanalytic Dialogues in 2002:

Louis Sander is one of the most ambitious, comprehensive, and profound psychoanalytic theorists of our time. Yet his work is not widely known outside the world of developmental psychoanalysis. Among these cognoscenti, Sander is revered as an intellectual godfather: He began looking at babies with crystal clarity before any of the original crop of infant observers did, influenced them all, and has retained his status as their intellectual hero. Exploring the theoretical implications of those observations, he proposes an exceptionally bold synthesis that brings systems theories from physics, neuroscience, and general biology to bear on the basic questions of psychic structure and motivation.

Louis Sander's bold and ambitious theoretical synthesis deserves careful attention from psychoanalysts of all persuasions. Sander's cutting-edge approach draws on infant observation research, nonlinear dynamic systems theories, and current biology, physics, and other “hard” sciences. He is rethinking the psychoanalytic approach to psychic structure, motivation, and therapeutic action. In so doing, he updates Freud's project of linking psychoanalysis with scientific paradigms, but without reductionism, epistemological naivete, or an implicit antipsychological attitude.

Sander emphasizes the dynamic relationships between elements in systems. His method draws parallels between the different levels of the functioning of natural systems, starting with the basic “biological” level of cells and organs and moving toward the psychic and interpersonal phenomena that are of greatest interest to psychoanalysts. In this way, he opens a window for a broad and inclusive “relational metapsychology.”

Stephen Seligman (2002). Louis Sander and Contemporary Psychoanalysis. Psychoanal. Dial., 12:1-10.

Wednesday, November 28, 2012

Jessica Benjamin - Intersubjective Views of Thirdness

"The introduction of the idea of intersubjectivity into psychoanalysis has many important consequences and has been understood in a variety of ways. The position I will develop in this paper defines intersubjectivity in terms of a relationship of mutual recognition—a relation in which each person experiences the other as a "like subject," another mind who can be "felt with," yet has a distinct, separate center of feeling and perception. The antecedents of my perspective on intersubjectivity lie on the one hand with Hegel (1807; Kojève 1969), and on the other with the developmentally oriented thinkers Winnicott (1971) and Stern (1985)—quite different in their own ways—who try to specify the process by which we become able to grasp the other as having a separate yet similar mind.

In contrast to the notion of the intersubjective as a "system of reciprocal mutual influence"—referring to "any psychological field formed by interacting worlds of experience" (Stolorow and Atwood 1992, p. 3)—adumbrated by intersubjective systems theorists Stolorow, Atwood, and Orange (Orange, Atwood, and Stolorow 1997),1 I emphasize, both developmentally and clinically, how we actually come to the felt experience of the other as a separate yet connected being with whom we are acting reciprocally. How do we get a sense that "there are other minds out there" (see Stern 1985)?

In highlighting this phenomenological experience of other minds, I—like other intersubjective critics of Freud's Cartesianism—emphasize the reciprocal, mutually influencing quality of interaction between subjects, the confusing traffic of two-way streets. But this theoretical recognition of intersubjective influence should not blind us to the power of actual psychic experience, which all too often is that of the one-way street—in which we feel as if one person is the doer, the other done to. One person is subject, the other object—as our theory of object relations all too readily portrays. To recognize that the object of our feelings, needs, actions, and thoughts is actually another subject, an equivalent center of being (Benjamin 1988, 1995a), is the real difficulty...."
(p. 6)

"To the degree that we ever manage to grasp two-way directionality, we do so only from the place of the third, a vantage point outside the two.2 However, the intersubjective position that I refer to as thirdness consists of more than this vantage point of observation. The concept of the third means a wide variety of things to different thinkers, and has been used to refer to the profession, the community, the theory one works with—anything one holds in mind that creates another point of reference outside the dyad (Aron 1999; Britton 1988; Crastnopol 1999). My interest is not in which "thing" we use, but in the process of creating thirdness—that is, in how we build relational systems and how we develop the intersubjective capacities for such co-creation. I think in terms of thirdness as a quality or experience of intersubjective relatedness that has as its correlate a certain kind of internal mental space; it is closely related to Winnicott's idea of potential or transitional space. One of the first relational formulations of thirdness was Pizer's (1998) idea of negotiation, originally formulated in 1990, in which analyst and patient each build, as in a squiggle drawing, a construction of their separate experiences together. Pizer analyzed transference not in terms of static, projective contents, but as an intersubjective process: "No, you can't make this of me, but you can make that of me."

Thus, I consider it crucial not to reify the third, but to consider it primarily as a principle, function, or relationship, rather than as a "thing" in the way that theory or rules of technique are things. My aim is to distinguish it from superego maxims or ideals that the analyst holds onto with her ego, often clutching them as a drowning person clutches a straw. For in the space of thirdness, we are not holding onto a third; we are, in Ghent's (1990) felicitous usage, surrendering to it.

Elaborating this idea, we might say that the third is that to which we surrender, and thirdness is the intersubjective mental space that facilitates or results from surrender. In my thinking, the term surrender refers to a certain letting go of the self, and thus also implies the ability to take in the other's point of view or reality. Thus, surrender refers us to recognition—being able to sustain connectedness to the other's mind while accepting his separateness and difference. Surrender implies freedom from any intent to control or coerce..."
(p. 7)

'If we grasp the creation of thirdness as an intersubjective process that is constituted in early, presymbolic experiences of accommodation, mutuality, and the intention to recognize and be recognized by the other, we can understand how important it is to think in terms of building a shared third. In shifting to an intersubjective concept of the third, we ground a very different view of the clinical process from the one espoused by those who use the concept of the third to refer to observing capacities and the analyst's relation to his own theory or thinking." (p. 19)

Jessica Benjamin (2004). Beyond Doer and Done to: An Intersubjective View of Thirdness. Psychoanalytic Quarterly, Vol. 73, pp. 5-46.

Wednesday, November 21, 2012

Daniel Stern - The ‘Pre-Narrative Envelope’: An Alternative View of ‘Unconscious Phantasy’ in Infancy

"This work grows out of a continuing effort to understand the nature of the infant's representational world and, in particular, to imagine how this world is created. Such a creation within the infant's mind would be easier to envision if we had a ‘basic unit’ of subjective, psychic experience of psychodynamic relevance to work with. Such a unit would serve as the building block for constructing the representational world. In psychoanalysis, the ‘basic unit’ of psychic experience is the ‘unconscious phantasy’. This article proposes the ‘pre-narrative envelope’ as an alternative way to view such a basic unit, especially its origin in early infancy.

Why is an alternative view needed, and what directions might it take? The point of reference for the concept of an ‘unconscious phantasy’ is contained in Freud's earlier views of a ‘primal phantasy’ (1916-17) and in the Kleinian view of an ‘unconscious phantasy (Isaacs, 1948). In these conceptions, ‘unconscious phantasies’ are inherited scenarios containing an object, aim and goal.

These scenarios are innate correlates or the psychic content of drive, and exist independently of experience, which only gives them local colour. Stated in that way, this is the clearest, most robust and radical psychoanalytic position on ‘unconscious phantasy’. It is the reference point of which all other positions are modifications. Even though a majority of psychoanalysts may not hold to this position in its pure form, their views are necessarily defined against this point of reference.

The desire to modify this reference point has been strong historically and remains so. The reasons for this are evident. First, the notion of a mental scenario that is inherited is hard to envision or explain. Second, many wish to give interactions with the environment a greater role in the formation of the ‘unconscious phantasy’. And thirdly, if the ‘unconscious phantasy’ is an inherited mental structure, there is little work of mental construction left for our enormous capacities, and the subject of thinking and representing in that case is of little interest, at least as concerns the formation of the basic unit of psychic experience. To be sure, in the traditional psychoanalytic view, ego processes play a crucial and necessary role in bringing the unconscious phantasy into psychic life. Nonetheless, the basic form of the unconscious phantasy is already established for the ego to work upon. Thus, ‘thinking’ and ‘representing’, as ego functions, are allocated a role in the transposition but not the creation of the basic form of the phantasy.

In spite of this interest in modifying the ‘reference position’, it is difficult to do so within the psychoanalytic framework. If one wishes to give a greater formative role to environmental interactions, and to ‘thinking’ and ‘representing’ which construct the mental landscape from these interactions, at least two things are needed. First, one would need a theory of ‘thinking’. However, psychoanalysis has never developed a real and independent theory of ‘thinking’. (Bion is a possible but partial and problematic exception. His work will not be discussed here. ‘Thoughts’ have remained the offspring and handmaidens of drives. In a sense, the pre-formed phantasy takes the place of the creational function of ‘thinking’. That is why psychoanalysis has been so concerned with the dialectic between absence and presence in the emergence of ‘thought’, instead of being interested in the role of ‘thought’ in creating the prior dialectic between non-existence and existence (existence containing both presence and absence).

Secondly, one would need a greater interest in, and a more elaborated perspective on the nature of observable interactions. Psychoanalysis, with its centre of gravity firmly in the intrapsychic, has been unable to do this. (There are of course some grand but individualistic exceptions such as Winnicott.)

Without a theory of ‘thinking’ or a systematic approach to interaction, the possibilities are limited for modification within a strict, traditional psychoanalytic frame. It is with this in mind that I will borrow some concepts of ‘thinking’ from cognitive science, and some infant observational approaches to interaction, and apply them to the psychoanalytic notion of drive. The result is an alternative view of the ‘unconscious phantasy’ which I will call a ‘pre-narrative envelope’ for reasons that will become clear.

Since the major thrust of this article is progressively to assemble the concept of a ‘pre-narrative envelope’ and demonstrate how it can further our understanding of infantile subjective experience, the acquisition of representational worlds, and of ‘thinking’ in infancy, I will summarize here the main features of this unit so the reader will have a clearer picture of where we are headed.

1. The unit must be clinically useful, potentially, and must be appropriate from a developmental perspective.

2. The backbone of the unit is the desire/motive with its goal-directedness. This is an expectable directrix of any psychodynamic unit and of all motivation-centred units of experience. It is certainly at the core of Freud's notions of drive, unconscious phantasy and the purposive ideas (representations-buts). It is interesting in this connection that Darwin in his notebooks muses that motives are the basic unit of the universe in that they are the functional units of evolution.1 From a different perspective, students of narrative structure have found motives and goal-orientation to be crucial narrative aspects (see below). Similarly students of affects (Scherer, 1986; Steiner-Krause, 1992), of motor action (von Cranach et al., 1982), of cybernetics (Céllerier, 1992), of ethology and others, all place goal-directedness at the core of their explanatory concepts.

Goal-directedness alone, however, is not sufficient to make such a unit ‘psychoanalytic’ or psychodynamic. Drives imply a psychic component, a structure of thought, e.g. unconscious phantasies, wishes and desires. I am not leaving these out. They will reappear below - but as indirect products of drive.

The scope of motivations and goals encompassed here is largely that developed by Sandler (1985), and Sandler and Sandler (1992), in which the goals of desires/motives include external and internal states of object-relatedness, affect states, and states of self-esteem and safety, as well as physiological need-satisfaction and consumatory acts in general.

The goal-directed unit of the motive/desire is indeed our ‘basic unit’ for understanding (parsing (découper), explaining and predicting) human behaviour. At the level of comprehending human behaviour psychodynamically or in terms of folk psychologies this unit is not reducible (Bruner, 1990; Dennett, 1978; Whiten, 1991). It is the basic unit and starting point for a subjective phenomenology underlying any clinical science of the mind.

3. The ‘pre-narrative envelope’ is a subjective experience that unfolds in time. It has a temporal structure that provides part of its coherence and meaning. This unit is like a musical phrase that loses its sense when cut up further and like a musical phrase moves, with an inevitability, to an end-state. A temporal dimension is not explicitly present in the concept of an ‘unconscious phantasy’ as it is for the ‘pre-narrative envelope’.

4. The ‘pre-narrative envelope’ has a coherence and meaning by virtue of its narrative-like structure which includes a dramatic line and the basic elements of a proto-plot, such as agent, action, goal, object, context.

5. It is a ‘pre-narrative’ unit because it arises before the emergence of language or narrative-producing abilities, but conforms to most of the structures essential to narrative. It is the unit from which narrative will emerge, transposed.

6. This unit is subject to revision sur-le-coup, après-coup and as transposed into a true narrative communication without losing its basic form.

7. The ‘pre-narrative envelope’ is not an innate structure, or the ego's discovery of such; rather, it results from the infant's own mental construction. This construction emerges from the infant's subjective experience with drives being enacted in an interpersonal context. It is an ‘emergent property’ of mind as currently conceived in the cognitive sciences (Céllerier, 1992; Churchland, 1984; Dennett, 1991; Edelman, 1990; Rummelhart and McClelland, 1986; Maturana and Varela, 1979).
The cognitive-science view of ‘thinking’1, borrowed and applied to the psychoanalytic question, ‘What is an unconscious phantasy in early infancy?’, can be summarized briefly below. In this view, the mind appears to process, in parallel and in partial independence, a large number of simultaneous mental happenings. During an experience, instinctual urgings, visual images, affect shifts, sensations, motor actions, ideas, states of arousal, language, place and space, time, etc., are all processed simultaneously in parallel throughout all ‘centres’ in the mind as well as in specialized ones devoted to processing each (‘Parallel Distributed Processing’ (PDP)). The parallel processing of each element is carried out with lower-level, local, mental operations which are never translatable into subjective experience. These mental processes are operationally unconscious."
(pp. 291-295)


1 It is not agreed upon nor clear what ‘thinking’ is. I will use the term in quotes to mean different mental operations and processes, some of which would be better called ‘pre-thinking’ - whatever that may be.

Daniel N. Stern (1992). The ‘Pre-Narrative Envelope’: An Alternative View of ‘Unconscious Phantasy’ in Infancy. Bul. Anna Freud Centre, Vol. 15, pp. 291-318

Passing of Daniel Stern - Nov 18, 2012 - Announcement from Columbia Psychoanalytic Center

The Columbia University Center for Psychoanalytic Training and Research mourn the passing of our esteemed colleague Daniel Stern, M.D. Dr. Stern was an internationally recognized leader and major contributor to the field of developmental psychology. His pioneering work on early affective mother-child was one of his leading activities. He has edited and authored many important books and articles in the field, among them Interpersonal World of the Infant, First Relationship and Motherhood Constellation. We extend our heartfelt condolences to his family. Those who knew him remember his intelligence, his warmth, his commitment and his friendship.

Eric R. Marcus, MD, Director, Columbia University Center

Wednesday, November 14, 2012

Jane Bunster - Flexibility in Treating the Difficult to Reach Patient

Editors Note: In this passage, Bunster summarizes her treatment of a patient whose psyche was organized around an autistic core. Bunster emphasizes the flexibility she needed to maintain in her analytic activity - moving back and forth between relatedness/ containing while also consistently interpreting what was happening in the analytic dyad.

"First, I tried to use what could be considered as ‘maternal reverie’, where I did my best to get in tune with her so that any deintegrative moves she might have made towards me were met with good-enough understanding and response. I thought in terms of the infantile transference. What she was furiously defending against was the pain of the loss of the mother/breast, which, in turn, she saw as attacking, retaliatory, and unforgiving. Any interpretation I might make needed two parts: first, the direct content and, then, analysis of the defence she used to prevent the interpretation/food being taken in and digested.

This was particularly apparent at times of holiday breaks and weekends. The sessions became more quiet and silent. Any feelings of loss had to be denied. If she denied my existence, no loss need be experienced and so she wiped me out of her mind, in the way she experienced I was doing to her whenever we separated from each other. Although she realized intellectually how cut off she was, she could make no link between thought and feelings.

My task was to try to stay patiently with her disconnectedness and annihilation and gradually make sense of it, always remembering that, underneath the withholdingness and locked-in-ness which may manifest itself as obstinacy, omnipotence, and manipulation, lay very great anxiety and perhaps fear of falling to bits.

In confronting and experiencing such primitive archetypal material, flexibility of approach seems essential. I have tried to show how useful the concept and the process of projective identification are in helping such a cut-off patient get more in touch with her feelings, thus modifying the intense conflicted areas and ameliorating the terror. If I can talk and make sense of these feelings, confidence can be gained that unconscious impulses need not be overwhelmingly destructive and imagination may then flow more freely." (pp. 43-44)

Jane Bunster (1993). The Patient Difficult to Reach: Omnipotence, projective identification and the primary self. Journal of Analytical Psychology, Vol. 38, pp. 37-44

Thursday, October 25, 2012

Michael Eigen - Soft and Hard Qualities

"Soft" and "hard" are universal expressive qualities that inform all our experience. We sense their interplay in the margin of our awareness throughout our lifetime. Their varying dissociations and interpenetrations color and texture our thoughts, feelings, sensations, and actions. They permeate objects of concern at every level of our existence and are subtly woven into the atmosphere of subjectivity as such. Without them our psychophysical existence would be more bland and dimensionless.

This theme is given a distilled representation in the Taoist yin-yang symbol, the Tai-chi-tu. But even this most coherent symbol of polarity-in-unity is too geometric to do justice to the subtle, interpenetrating flow of these qualities in moment-to-moment living. To be sure, hard and soft often do set each other off. They may oppose or complement each other in rather clearly distinguishable ways: viz., the erect penis and adaptable vagina, hard-headedness/soft-heartedness (or vice-versa), and the like. But even (especially?) in sexual intercourse it becomes most difficult to know clearly where the softness and where the hardness, as they melt into and permeate one another, ineffably fluid. The rock gradually dissolves in the water, but the water can no longer be described simply as "soft."

The qualities "soft" and "hard" are virtually omnipresent building blocks of personality. At each moment of development the self senses both itself, its capacities, functions, and objects in terms of soft and hard resonances. Its organizational capacities are partly steered by an implicit awareness of the soft-hard contours of sensed mental and physical realities. Blocks and distortions in the perception of these qualities and their shifting emotional meanings both reflect and perpetuate developmental deficiencies. Many individuals often are relatively insensitive to or misinterpret these vital cues of psychic movement.

The therapeutic task of helping patients to "experience their experience" is aided by the therapist's sensitivity to the incessant and complex interplay of soft and hard currents in mental life. These currents may act as moment-to-moment cues of psychic possibilities, which often go unheard or unheeded. Most patients tend to run roughshod over them or distort their meanings in accord with persistent, rigid patterns. Individuals are usually filled with too much anxiety noise to truly feel and value the subtle expressive forces which ever form part of the background of existence. Occasionally patients make inflated use of background qualities and turn what could be "news of difference" into chronic, narcissistic shields. The creative recognition of the flow of softness-hardness qualities also may threaten areas of affective flattening built up as protection against dangers associated with psychic fertility.

In the present paper I record some aspects of the struggle involved in keeping oneself open to fresh perceptions of the meaning and use of softness-hardness cues in personal development. I focus on the appearance of softness-hardness qualities in dream life and how these qualities reflect actual or potential shifts in self-feeling. The patients involved often tended to disregard or ward off experiencing the genuinely new nuances of self-feeling to which their dreams might give rise. It was largely up to the therapist to sustain the integrity of the dreamer's attempt to create perspectives outside well-worn destructive circles or stereotypes—until the patient could increasingly own this function. The meaning-making processes described here do not claim to be the only or "right" ones. Any number of possible avenues might have led to development. What is perhaps most important is the personal faith and investment in meaning creation itself, a communal process in which we stimulate each other's appetites for meaning and creative shifts in self-feeling."
(pp. 267-268)

Michael Eigen (1980). A Note on Soft and Hard Qualities. American Journal of Psychoanalysis, Vol. 40, pp. 267-271.

Monday, October 15, 2012

Anna Bravesmith - Supervision and Imagination

"The role of imagination in supervision is central and imaginative activity in both supervisee and supervisor discovers the unconscious layers of the analytic work which cannot be known consciously at the outset. The supervisor needs to be open to playful reverie and fully able to associate freely to material that the supervisee brings. In this paper the main argument is that imagination itself is essential but that, to borrow a metaphor from engineering, reasonable deduction acts as a fulcrum for the pivotal actions of the imagination. The argument is elaborated to differentiate two kinds of activity which might be thought of as use and misuse of imagination. These two kinds of internal activity have been further differentiated and described as ‘imagination’ and ‘the imaginary’ by Colman (2006, p. 22); he says:

imaginary fantasies lack the substance and depth of real imagination [using] fantasy as a way of defending against all those aspects of reality concerned with absence and loss.

Without the fulcrum of reason and reality checking defensive and misleading fantasies can arise in the supervisor and embroil both participants in the supervision in a fantasy world. This is like a lever with no fixed point which then becomes dysfunctional. In contrast grounded imaginative activity is an incredibly subtle and versatile tool.

The deeply integrative potential of supervision emphasized by Searles (1955), Perry (2003), McGlashan (2003) and others rests largely on the maintenance of a mutual relationship in which closeness and distance are both accepted as complementary and equally valuable attributes. In closeness the supervisor comes alongside the supervisee and has an emotional and imaginative experience which, at some level, is analogous to what is happening in the therapeutic work. With distance the supervisor is able to evaluate, reflect and constructively criticize or ‘break the enchantment’ (Schaverien 2003) of over identification between analyst and patient. This evaluative function is often emphasized in organizations where supervisors take a monitoring role with close links to management and its structures. Indeed the word ‘supervision’, for most people outside the field of psychotherapy, is still associated with its historical roots as a term for the overseeing of work on the factory floor and a simple fixed hierarchical relationship. In analytic circles the word has been expanded to include what Gediman and Wolkenfield called the ‘complex multidirectional network’ (1980, p. 236) of influences between patient/therapist/supervisor, with dynamic shifts in distance and closeness. The supervisor's surrender to imagination also necessitates a temporary lowering of ego function as she/he has to allow stray associations and sensations to enter consciousness without censorship. This momentarily changes the hierarchical model in favour of greater mutuality and shared experience. The supervisor at times has to relinquish the bastion of the ego in the same way that this has to happen in the analyst in an analysis.

The term supervision has been universally adopted and is unlikely to be replaced by any other term but Perry (2003, p. 190) says:

The term ‘subvision’ may be more evocative since both supervisor and supervisee are concerned with what happens beneath surface consciousness. ‘Prismatic vision’ seems to me to be an even better name for the process.

He explains that prismatic vision is the process whereby material is brought to the consultation like undifferentiated white light which gains its visibility and colour when seen through the supervisory prism, or process.

The role of imagination in supervision is closely related to this idea of giving colour to experience which may be initially undifferentiated, white or grey. However imagination can be mercurial, shifting in its value so that it may sometimes appear as the ‘deceiving elf’ of fancy as in Keats's ‘Ode to a Nightingale’ (1819) quoted above. This can happen when the supervisor and supervisee are enraptured in a joint fantasy which they forget to analyse and instead retreat into, thereby ignoring their subjectivity and the emergence of a third position. As Zinkin (1996, p. 247) states:

supervision is actually a shared fantasy… it works best if both remain aware that what they are jointly imagining is not true. Both can profit enormously … there is teaching and learning to be found in this joint imaginative venture.

My interpretation of Zinkin's contentious remark is that the imagination generates working hypotheses in supervision which can be negated, altered, extended as we go along but that if we are attached to defending their ‘truth’ at any stage we are probably in a defensive state of mind. He goes further by saying that this can be a folie á deux where both supervisor and supervisee collude.

In exploring the role of imagination in supervision I will examine the differentiation between defensive and creative imaginative functions with particular reference to my work as a training supervisor for an analytic psychotherapy organization. This is linked with the use of a Jungian perspective which I have found particularly useful in the practice of supervision because the Jungian understanding of the ego-self relationship is congruent with openness to parallel process phenomena. The emergence of feelings, images, thoughts and atmospheres which derive from the patient in direct experience in supervision is most commonly called parallel process and is the factor which transforms supervision from a dyadic activity into a triadic one. In reality it often constellates as multi-layered, including the mirroring of dynamics in more than three relationships.

The Jungian conceptualization of an internal mutually rewarding communication between ego and self provides a frame for the techniques I describe in supervision. These are essentially the same as those used in analysis but need to be harnessed differently in order to avoid simply becoming analysis of the supervisee. The techniques are harnessed and the supervisor even ‘blinkered’ to achieve a focus only on the track ahead—that is the further understanding of the supervisee's work with a patient and excludes the analysis of other wider aspects of his/her personality, no matter how tempting it may be to go down that path. For example when supervising a supervisee who appears to be detached from his/her patient the supervisor may feel that this reflects an incapacity to connect with others on an emotional level. This may be a difficulty which is observable in the work with more than one patient over years, thus suggesting that the block lies within the supervisee's personality and is possibly part of a schizoid pattern. The temptation might be to interpret the defensive nature of the supervisee's pattern going deeper into its origins, relating it to the transference to the supervisor and to archetypal complexes. However this would erode the boundary between supervision and analysis and compromise the supervision. The supervisee would probably feel intruded into and any concurrent analysis going on elsewhere could be compromised. This situation can be an unconscious acting out of the supervisor's rivalry with the supervisee's analyst or simply an over-entanglement with the supervisee." (pp. 101-103)

Anna Bravesmith (2008). Supervision and Imagination. Journal of Analytical Psychology, Vol. 53, pp. 101-117

Monday, October 8, 2012

Richard Reichbart - The Concept of Screen Memories: An Historical Review

"The general sense of a "screen memory" today is of a memory characterized by a clear and heightened sense of reality, focused on a seemingly innocuous event that screens from memory a contiguous or associated traumatic event. This screen memory is generally considered to be unchanged and of long standing; because of its seemingly innocuous nature, its retention is often something of a mystery to its possessor. Indeed, this is a kind of screen memory, but as will become clear it is not the only one that Freud identified or that was elaborated by later commentators. Freud was very much fascinated by screen memories, in a way we do not appear to be today. Modern case presentations, for example, would not generally be formulated using what Freud wrote in 1914: "Not only some but all of what is essential in childhood has been retained in these [screen] memories. It is simply a question of knowing how to extract it out of them by analysis. They represent the forgotten years of childhood as adequately as the manifest content of a dream represents the dream-thoughts" (Freud 1914, p. 148).

Sixty-six years later, Greenacre (1980) wrote that the "functions and significance of screen memories still seem of marginal importance to many analysts" (p.40). In fact, discussions about the "screening" function of memories have tended to generalize to such an extent, often introducing new terms (see, e.g., Lewin 1946; Greenson 1958; Reider 1953; Blum 1994, p. 28), that even the particular characteristics of a screen memory, such as its brightness and immediacy, its intactness throughout most of a treatment, and its lengthy imperviousness to analysis, have been lost.

There are probably a number of reasons that screen memory has come into disfavor as a concept worth exploration in contemporary work. Two come to mind. The first is that screen memory is sometimes considered an antiquated and dusty concept, involved solely in reconstruction of the patient's past, a relic of the old archaeological model of psychoanalysis that Freud initially favored. In other words, a screen memory is not seen as alive and crucial in the here and now of the transference interactions of a treatment or in the establishment of object relations. And it is true that despite Freud's fascination with screen memory, at no point did he specifically discuss its importance to the transference. Many decades later, Mahon and Battin (1981; Mahon and Battin-Mahon 1983) did make masterful observations about the role of the screen memory in the transference, but by comparing this memory to a container whose contents flow into the transference only when the power of the memory begins to break up as treatment progresses, they failed to convey the sense of overwhelming power that a screen memory can exert on the transference from the very beginning of treatment. On the other hand, it appears to have escaped notice by subsequent commentators that in one brief and passing reference Freud made an incisive observation about the importance of screen memory in establishing a person's object choice, which I elaborate on below. Indeed, his examples of screen memory can be interpreted as embodying this concept. In what follows I will emphasize this aspect of screen memories, as well as the importance of screen memories to object relations in general.

Freud's fascination with screen memories first appeared in print in 1899, prior to the appearance of The Interpretation of Dreams, in a paper that in a letter to Fliess he said he liked immensely (Masson 1985, p. 351). Here he formally coined the term screen memory and described the characteristics of the phenomenon, using as an example a disguised memory of his own from his adolescence, as well as examples from a paper published by V. and C. Henri in 1897. He stated that a screen memory is a "compromise": "What is recorded as a mnemic image is not the relevant experience itself—in this respect the resistance gets its way; what is recorded is another psychical element closely associated with the objectionable one." Screen memories are like "shams": "they are not made of gold themselves but have lain beside something that is made of gold" (1899, p. 307). Very unlike other childhood memories, a screen memory has an hallucinatory quality; it is what he referred to as "ultra-clear." Diagnostically, Freud did not go beyond contending somewhat tentatively,as had the Henris, that screen memories occur frequently in the childhood memory of "neurotics."

As his thoughts advanced, Freud stated more emphatically how significant screen memories are to psychoanalysis. In 1914 his publications suggested that his thinking had advanced considerably. Not only did he make the remark I have cited about a screen memory containing all of what is essential in childhood; he also published the Wolf Man case, in which screen memories played a prominent role. In 1920, Freud added an intriguing footnote to Three Essays on the Theory of Sexuality (1905). There he compared a screen memory developmentally to a fetish: "behind the first recollection of the fetish's appearance there lies a submerged and forgotten phase of sexual development. The ‘fetish,’ like the screen-memory, represents this phase and is thus a remnant and precipitate of it" (pp. 154-155).Further Elaborations

Writing after Freud, a number of commentators elaborated on the concept of the screen memory. In 1929 Glover clearly stated that a screen memory is not necessarily a memory of an inconsequential event that stands in for a traumatic one. Rather, a traumatic event can act as a screen (and a very convincing one) to a greater trauma (see Good 1998). The example Glover provided was of a patient who was circumcised in a particularly insensitive manner when he was between three and a half and four years of age, an event of which he had no memory. But he did remember in detail an incident that took place on the same day. He had been visiting in the house of the doctor, a family friend of the mother's, who performed the circumcision later that day, and had burned his hand on a hot stove. He recalled the occasion of the accident, its cause, the stove, the dressings, and so on in extraordinary detail, but amnesia for the circumcision itself was complete (Glover 1929).

In 1927 Fenichel used an economic model: a screen memory develops as a "safety valve" (p. 113) in consequence of the pressure of repressed material rising toward consciousness. The conscious recall of the screen memory represents a "partial discharge" (p. 113), so that the pressure is then diminished and repression becomes possible. Fenichel also observed that when the ego struggles with a troubling perception, which it attempts to repress, it develops a "hunger for screen-experiences" (p. 114). In effect, the ego searches for screen experiences and is "economically eased when it finds them" (p. 114). He emphasized that a screen memory often has attached to it a command to remember, an "injunction to note" (p. 116). That is, the individual remembers that at the time of the event represented in the screen memory, he felt an inner injunction, which Fenichel characterized as "Pay attention! You must remember this scene as long as you live!" (p. 114; see also Fenichel 1929). To elaborate on Fenichel, what could equally be stated is that there is an unconscious injunction that is exactly the opposite and of comparable force. It is "Forget, forget as long as you live" the underlying trauma that the screen memory replaces. This internalized vow is what makes the screen memory so impervious to analysis.

Probably no commentator after Freud attempted to characterize screen memories more than Greenacre. Over and over, she emphasized that screen memories are unlike other memories or dreams: "Screen memories are especially helpful, but are often disregarded by students and some analysts who have tried unprofitably to treat them as though they were dreams. Because they are less fluid than dreams and more firmly organized in their defensive function, immediate free association cannot be demanded" (Greenacre 1981, pp. 42-43). Elaborating on what Glover suggested, she contended that there are two forms of screen memory, the one indicated by Freud, in which the memory is apparently of something inconsequential and attended by a special visual "brightness," and another, in which there is a "stubborn persistence but without brightness, and in which the content appears factually disturbing and very little elaborated" (Greenacre 1949, p. 74). She contended that screen memories exist on a continuum, running the gamut from those in which a seemingly inconsequential incident is brightly illuminated and remembered to those in which "really traumatic events may be seized upon as representations of the earliest anxious fantasies or experiences of the child and may be used variously as justification, verification or gratification" (p. 76). This type of screen memory, characterized by persistence rather than triviality and brightness, tends to remain factual and isolated. It is "stubbornly resistant to analysis" (p. 77) and often will not yield to analysis until the end of treatment. (As will be seen, however, the data in this case appear to contradict Greenacre's comment about the lack of brightness attributable to screen memories involving traumatic events.) In and of itself, Greenacre remarked, the screen memory can become symbolic of reality testing for a patient, in which "reality [is used] to cover reality" (p.83).

Greenacre (1949) attempted to explain what accounts for the power of a screen memory, suggesting among other things that the stage of superego development at the time of the event for which the screen memory is substituted has a decisive influence because the superego determines the extent and intensity of the need to deny and contributes to the sense of "actual watchfulness in the screen memory" (p. 76). She hypothesized that the degree of sadomasochistic character structure also plays a role: the more sadomasochistic the character, the more likely it is that the screen memory will involve really traumatic events, and that the memory will be symbolically used to characterize Fate and to justify a sadomasochistic posture toward the world. (She did not explain why this should be; further on, I will attempt to do so.) After Greenacre, the most important contribution has been that of the Mahons, who emphasized the importance of the screen memory to the ongoing psychoanalytic process, and who stated that dissipation of the power of the screen memory is a signal that the terminal phase of psychoanalysis has begun."
(pp. 457-461)


Richard Reichbart (2008). Screen Memory: Its Importance to Object Relations and Transference. J. Amer. Psychoanal. Assn., 56:455-481

Sunday, September 30, 2012

C.G. Jung on Archetypes and Adaptation

"Archetypes are systems of readiness for action, and at the same time images and emotions. They are inherited with the brain structure - indeed they are its psychic aspect. They represent, on the one hand, a very strong instinctive conservatism, while on the other hand they are the most effective means conceivable of instinctive adaptation. They are thus, essentially, the cthonic portion of the psyche...that portion through which the psyche is attached to nature."

C.G. Jung (1921) Psychological Types, The Collected Works of C.G. Jung, Vol. 6, par. 684, Princeton, NJ: Bollingen - Princeton University Press

Saturday, September 22, 2012

Jonathan Shedler - Distinquishing Characteristics of Psychodynamic Psychotherapies

Excerpted from Jonathan Shedler (2010) The Efficacy of Psychodynamic Psychotherapy, American Psychologist, Vol. 65, No. 2, pp. 98–109

Seven features reliably distinguished psychodynamic therapy from other therapies, as determined by empirical examination of actual session recordings and transcripts (note that the features listed below concern process and technique only, not underlying principles that inform these techniques; for a discussion of concepts and principles, see Gabbard, 2004; McWilliams, 2004; Shedler, 2006a):

1. Focus on affect and expression of emotion. Psychodynamic therapy encourages exploration and discussion of the full range of a patient’s emotions. The therapist helps the patient describe and put words to feelings, including contradictory feelings, feelings that are troubling or threatening, and feelings that the patient may not initially be able to recognize or acknowledge (this stands in contrast to a cognitive focus, where the greater emphasis is on thoughts and beliefs; Blagys & Hilsenroth, 2002; Burum & Goldfried, 2007). There is also a recognition that intellectual insight is not the same as emotional insight, which resonates at a deep level and leads to change (this is one reason why many intelligent and psychologically minded people can explain the reasons for their difficulties, yet their understanding does not help them overcome those difficulties). 

2. Exploration of attempts to avoid distressing thoughts and feelings.
People do a great many things, knowingly and unknowingly, to avoid aspects of experience that are troubling. This avoidance (in theoretical terms, defense and resistance) may take coarse forms, such as missing sessions, arriving late, or being evasive. It may take subtle forms that are difficult to recognize in ordinary social discourse, such as subtle shifts of topic when certain ideas arise, focusing on incidental aspects of an experience rather than on what is psychologically meaningful, attending to facts and events to the exclusion of affect, focusing on external circumstances rather than one’s own role in shaping events, and so on.  Psychodynamic therapists actively focus on and explore avoidances.

3. Identification of recurring themes and patterns. Psychodynamic therapists work to identify and explore recurring themes and patterns in patients’ thoughts, feelings, self-concept, relationships, and life experiences.  In some cases, a patient may be acutely aware of recurring patterns that are painful or self-defeating but feel unable to escape them (e.g., a man who repeatedly finds himself drawn to romantic partners who are emotionally unavailable; a woman who regularly sabotages herself when success is at hand). In other cases, the patient may be unaware of the patterns until the therapist helps him or her recognize and understand them.

4. Discussion of past experience (developmental focus). Related to the identification of recurring themes and patterns is the recognition that past experience, especially early experiences of attachment figures, affects our relation to, and experience of, the present. Psychodynamic therapists explore early experiences, the relation between past and present, and the ways in which the past tends to “live on” in the present. The focus is not on the past for its own sake, but rather on how the past sheds light on current psychological difficulties. The goal is to help patients free themselves from the bonds of past experience in order to live more fully in the present.

5. Focus on interpersonal relations. Psychodynamic therapy places heavy emphasis on patients’ relationships and interpersonal experience (in theoretical terms, object relations and attachment). Both adaptive and nonadaptive aspects of personality and self-concept are forged in the context of attachment relationships, and psychological difficulties often arise when problematic interpersonal patterns interfere with a person’s ability to meet emotional needs.

6. Focus on the therapy relationship. The relationship between therapist and patient is itself an important interpersonal relationship, one that can become deeply meaningful and emotionally charged. To the extent that there are repetitive themes in a person’s relationships and manner of interacting, these themes tend to emerge in some form in the therapy relationship. For example, a person prone to distrust others may view the therapist with suspicion; a person who fears disapproval, rejection, or abandonment may fear rejection by the therapist, whether knowingly or unknowingly; a person who struggles with anger and hostility may struggle with anger toward the therapist; and so on (these are relatively crude examples; the repetition of interpersonal themes in the therapy relationshipis often more complex and subtle than these examples suggest). The recurrence of interpersonal themes in the therapy relationship (in theoretical terms, transference and countertransference) provides a unique opportunity to explore and rework them in vivo. The goal is greater flexibility in interpersonal relationships and an enhanced capacity to meet interpersonal needs.

7. Exploration of fantasy life. In contrast to other therapies in which the therapist may actively structure sessions or follow a predetermined agenda, psychodynamic therapy encourages patients to speak freely about whatever is on their minds. When patients do this (and most patients require considerable help from the therapist before they can truly speak freely), their thoughts naturally range over many areas of mental life, including desires, fears, fantasies, dreams, and daydreams (which in many cases the patient has not previously attempted to put into words). All of this material is a rich source of information about how the person views self and others, interprets and makes sense of experience, avoids aspects of experience, or interferes with a potential capacity to find greater enjoyment and meaning in life.

The last sentence hints at a larger goal that is implicit in all of the others: The goals of psychodynamic therapy include, but extend beyond, symptom remission. Successful treatment should not only relieve symptoms (i.e., get rid of something) but also foster the positive presence of  psychological capacities and resources. Depending on the person and the circumstances, these might include the capacity to have more fulfilling relationships, make more effective use of one’s talents and abilities, maintain a realistically based sense of self-esteem, tolerate a wider range of affect, have more satisfying sexual experiences, understand self and others in more nuanced and sophisticated ways, and face life’s challenges with greater freedom and flexibility. Such ends are pursued through a process of self-reflection, self-exploration, and self-discovery that takes place in the context of a safe and deeply authentic relationship between therapist and patient.

Thursday, September 20, 2012

Jonathan Shedler - Robust Empirical Support for Psychodynamic Treatment

Abstract: "Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as "empirically supported" and "evidence based." In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings." (p. 98)

Discussion: "One intent of this article was to provide an overview of some basic principles of psychodynamic therapy for readers who have not been exposed to them or who have not heard them presented by a contemporary practitioner who takes them seriously and uses them clinically. Another was to show that psychodynamic treatments have considerable empirical support. The empirical literature on psychodynamic treatments does, however, have important limitations. First, the number of randomized controlled trials for other forms of psychotherapy, notably CBT, is considerably larger than that for psychodynamic therapy, perhaps by an order of magnitude. Many of these trials—specifically, the newer and better-designed trials—are more methodologically rigorous (although some of the newest psychodynamic randomized controlled trials, e.g., that of Clarkin et al., 2007, also meet the highest standards of methodological rigor). In too many cases, characteristics of patient samples have been too loosely specified, treatment methods have been inadequately specified and monitored, and control conditions have not been optimal (e.g., using wait-list controls or "treatment as usual" rather than active alternative treatments—a limitation that applies to research on empirically supported therapies more generally). These and other limitations of the psychodynamic research literature must be addressed by future research. My intent is not to compare treatments or literatures but to review the existing empirical evidence supporting psychodynamic treatments and therapy processes, which is often underappreciated.

In writing this article, I could not help being struck by a number of ironies. One is that academicians who dismiss psychodynamic approaches, sometimes in vehement tones, often do so in the name of science. Some advocate a science of psychology grounded exclusively in the experimental method. Yet the same experimental method yields findings that support both psychodynamic concepts (e.g., Westen, 1998) and treatments. In light of the accumulation of empirical findings, blanket assertions that psychodynamic approaches lack scientific support (e.g., Barlow & Durand, 2005; Crews, 1996; Kihlstrom, 1999) are no longer defensible. Presentations that equate psychoanalysis with dated concepts that last held currency in the psychoanalytic community in the early 20th century are similarly misleading; they are at best uninformed and at worst disingenuous.

A second irony is that relatively few clinical practitioners, including psychodynamic practitioners, are familiar with the research reviewed in this article. Many psychodynamic clinicians and educators seem ill-prepared to respond to challenges from evidence-oriented colleagues, students, utilization reviewers, or policymakers, despite the accumulation of high-quality empirical evidence supporting psychodynamic concepts and treatments. Just as antipsychoanalytic sentiment may have impeded dissemination of this research in academic circles, distrust of academic research methods may have impeded dissemination in psychoanalytic circles (see Bornstein, 2001). Such attitudes are changing, but they cannot change quickly enough. Researchers also share responsibility for this state of affairs (Shedler, 2006b). Many investigators take for granted that clinical practitioners are the intended consumers of clinical research (e.g., Task Force on Promotion
and Dissemination of Psychological Procedures, 1995), but many of the psychotherapy outcome studies and meta-analyses reviewed for this article are clearly not written for practitioners. On the contrary, they are densely complex and technical and often seem written primarily for other psychotherapy researchers—a case of one hand writing for the other. As an experienced research methodologist and psychometrician, I must admit that deciphering some of these articles required hours of study and more than a few consultations with colleagues who conduct and publish outcome research. I am unsure how the average knowledgeable clinical practitioner could navigate the thicket of specialized statistical methods, clinically unrepresentative samples, investigator allegiance effects, inconsistent methods of reporting results, and inconsistent findings across multiple outcome variables of uncertain clinical relevance. If clinical practitioners are indeed the intended "consumers" of psychotherapy research, then psychotherapy research needs to be more consumer relevant (Westen, Novotny, & Thompson-Brenner, 2005).

With the caveats noted above, the available evidence indicates that effect sizes for psychodynamic therapies are as large as those reported for other treatments that have been actively promoted as "empirically supported" and "evidence based." It indicates that the (often unacknowledged) "active ingredients" of other therapies include techniques and processes that have long been core, centrally defining features of psychodynamic treatment. Finally, the evidence indicates that the benefits of psychodynamic treatment are lasting and not just transitory and appear to extend well beyond symptom remission. For many people, psychodynamic therapy may foster inner resources and capacities that allow richer, freer, and more fulfilling lives."
 (pp. 106-107)

Jonathan Shedler (2010) The Efficacy of Psychodynamic Psychotherapy, American Psychologist, Vol. 65, No. 2, pp. 98–109

Tuesday, September 18, 2012

Donnel Stern - Dissociation and Understanding

"All understanding is context dependent, and one of the most significant contexts for clinical purposes is the self-state. How we understand the other, and ourselves, depends on the state(s) we occupy. Dissociations between an analyst's self-states can, therefore, limit or impede understanding of the analysand by depriving the analyst of a fitting context within which to grasp what the analysand says and does. Clinical understanding may require the breach of such dissociations...The claim that all experience is continously constructed does not contradict our everyday recognition that some meanings are remarkably enduring. It is entirely consistent with the idea that we continuously create our experience anew to suggest that in some cases we construct the same meaning, or the same pattern in experience, over and over again. To put the point in conventional psychoanalytic language: unformulated experience can be highly structured—though never so structured that multiple interpretations are excluded. Even those structured meanings, though, remain processes. Even the most highly organized unformulated meanings are therefore not static objects or ruts worn in the brain, and never absolute, but predispositions toward certain kinds of meaning-making and away from others...." (p. 844)

"But no matter whether it is the analyst or the analysand who resolves the dissociation first, the story does not end here. Understanding is more mysterious than the mere absence of dissociation; it does not necessarily fall into place as soon as our unconscious reasons to avoid it vanish. The view that comes to us from Heidegger, Gadamer, Merleau-Ponty, and others is that there is no way to codify the process by which understanding is reached. No one can say exactly why understanding comes about when it does, why horizons fuse now and not five minutes ago or yesterday, why language becomes able in one moment to contain experience that the moment before it could not. Even after dissociation has been resolved, the most we can do is allow history, or tradition, or the speech and conduct of the other, to act freely within us. We cannot decide to understand, even under the best of circumstances; we can only strive to put ourselves in the best position for understanding to occur. And so, while the resolution of the analyst's dissociation is crucial, it guarantees nothing: it merely means that the circular movement that may result in the expansion and flowering of meaning can occur with less obstruction by unconsciously held motivation. New understanding may follow immediately—or it may not. Resolving dissociations gives language its head, but what language will do then is beyond our capacity to know." (p. 871)

Donnel B. Stern (2003). The Fusion of Horizons: Dissociation, Enactment, and Understanding. Psychoanalytic Dialogues, Vol. 13, pp. 843-873

Sunday, September 16, 2012

The Psychoanalytic Muse Reaches 10,000 Views

The Psychoanalytic Muse came into being on March 10, 2010.  This weekend, in just 2.5 years, it reached a cumulative total of 10,000 views from 90 countries around the world.  Such a tremendous response underscores the vibrancy that the ideas and practices developed by Freud, Jung, Adler, Ferenczi, Klein, Winnicott, Fordham, Hillman, Fairbairn, Kohut and others continue to have in our contemporary situation.  Out of 146 posts, the most frequently read posting, by a margin of two to one, is the passage from Glen Gabbard and Thomas Ogden's On Becoming a Psychoanalyst.  Freud's Remembering, Repeating and Working Through followed closely by Philip Bromberg's A Relational View of Resistence were the next two most frequently read postings.  The most frequently accessed post by a Jungian author was the one titled Don Kalsched on the Defenses of Trauma.  Thank you for your continued interest in analytic literature and this blog.

Thursday, September 13, 2012

Ferro and Basile - Types of Countertransference Experience in the Analytic Field

"The field concept, originally formulated by Willy and Madeleine Baranger (Baranger & Baranger, 1961-62) has gradually assumed increasing complexity (M. Baranger, 1992; Eizirik 2005; Ferro 1996, 2002a, b;). Initially regarded as a situation whereby the products of the patient-analyst encounter are seen in terms of crossed resistances, and hence of the formation of bulwarks that are subsequently broken down by interpretations resulting from the analyst's ‘second-look’ capability, the field has increasingly become the locus of the multiple potentialities of analyst and patient alike and of all the possible worlds that may be opened up by their encounter. As we see it, it is not only a spatial but also a temporal field, inhabited by the present and the history, which constantly affords vistas onto the future. It is a field in a state of perennial transformation, a characteristic of which nothing can ever remain outside it after the ‘big bang’ of the possible worlds generated by the patient-analyst encounter within the setting. Places in the field are the present analyst-patient relationship, as well as their histories, transferences, and so on.

The field has a breath of its own, whose inhalation phase signals the arrival (or unfreezing) within it of lumps of unthinkability, while its exhalation is the collapse that follows every saturated interpretation, which reduces it to a point so as to prepare it for future expansion. This is of course an incessant movement. Another feature of the field is that sooner or later it must, however slightly, be infected by the patient's illness, and indeed itself contract that illness, in order to become the locus of the treatment and hence of transformations.

Thus, the field has an oscillatory character, swinging between the constant opening up of meaning (negative capability) on the one hand, and the unavoidable closure of meaning when it forgoes all possible stories in favour of the one pressing most strongly to be told (the selected fact).....

This suggests to me that, on the basis of a Bion-inspired view of the field enriched with concepts extrapolated from narratology, a whole series of progressively higher countertransference levels can be distinguished:

Countertransference level 0: When the field itself becomes the narrator and metabolizer of what happens in it, it digests, transforms and alphabetizes the primitive emotions aroused in it, and the signals of its functioning are picked up by the analyst, who is thus enabled to modulate them continuously. This is merely an ideal situation, because caesuras of various kinds will inevitably mobilize the events of the field. The characters of the session themselves assume the task of describing what is happening, thus allowing the analyst's interpretations to modulate the movements of the field. The analyst presides over a process co-generated by himself.

Countertransference level 1: The field is no longer able to absorb and modulate its own tensions, which instead impinge on the particular locus of the field that is the analyst's mind, thereby arousing in him an active, conscious reverie which he perceives and uses.

Countertransference level 2: When the field's tensions are so high that they overflow its central part, they overwhelm the analyst's capacity for reverie and activate particular experiences on his part, on which he must work inside himself in order, on the one hand, to digest and metabolize them and, on the other, to use them for understanding the patient and where appropriate for giving interpretations.

Countertransference level 3: The overflowing is so severe that the analyst as it were takes the problem home with him at night. Something remains encysted and needs to be worked through, for example by the precious tool of countertransference dreams.

Countertransference level 4: The overflowing is so bad that the analyst's very analytic function is overwhelmed, resulting in breaches of the setting ranging from a physical illness in the analyst to unrecognized enactments or dramatic manifestations that preclude continuation of the analysis. A field of this kind is imbued with the violations of the setting so well described by Gabbard & Lester (1995), in which it has not been possible to dissolve the countertransference and to manage it on the level of thought, so that it becomes a ‘thing’ or ‘fact’. At this point, given that one of the components of analysis — the setting — is lacking, what takes place can simply no longer be called analysis."
(pp. 4-5)

Antonio Ferro and Roberto Basile (2008). Countertransference and the characters of the psychoanalytic session. Scandinavian Psychoanalytic Review, Vol. 31, pp. 3-10

Thursday, September 6, 2012

Elizabeth Urban: Jungian and Kleinian Notions of the Inner World

"A major, if not the major, difference between Freud and Jung lay in their views about the inner world. Freud's main emphasis was on the way contents of the mind are derived from personal experience, whereas Jung's studies viewed the mind as innately endowed with a priori configurations that encompass far more than personal contents. Klein too departed from Freud on this point, and the Controversial Discussions of the British Psycho-Analytical Society revolved around this issue (Hinshelwood 1989). Both Jung and Klein thought that the primary contents of the mind are inextricably bound up with the instincts, that, in fact, they are the mental representations of instincts.

According to Jung, the primary content of the psyche is the archetype. In contrast to instincts, the archetypes are ‘inborn forms of "intuition" ‘(Jung 1919, p. 133), analogous to instinct, with the difference that whereas instinct is a purposive impulse to carry out some highly complicated action, intuition is the unconscious, purposive apprehension of a highly complicated situation. (ibid. p. 132)

Jung also notes the similarities between archetypes and instincts. The archetypes make up the collective unconscious, which is universal and impersonal; that is, it is the same for all individuals. Instincts, according to Jung, are also impersonal and universal, and are, also like the archetypes, hereditary factors of a dynamic or motivating character. Thus, instincts ‘form very close analogues to the archetypes, so close, in fact, that there is good reason for supposing that the archetypes are the unconscious images of the instincts themselves’ (Jung 1936, pp. 43-4). Elsewhere he writes that the archetype ‘might suitably be described as the instinct's perception of itself, or as the self-portrait of the instinct’ (Jung 1919, p. 136).

Archetypes described in this way are virtually the same as Klein's unconscious phantasies. She writes, ‘I believe that phantasies operate from the outset, as do the instincts, and are the mental expression of the activity of both the life and death instincts’ (Klein 1952, p. 58). Isaacs presents a fuller exposition of the relationship between phantasies and instincts than does Klein. Isaacs states that ‘phantasies are the primary content of unconscious mental processes’ (Isaacs 1952, p. 82). ‘This "mental expression" of instinct is unconscious phantasy. Phantasy is (in the first instance) the mental corollary, the psychic representative, of instinct’ (ibid., p. 83).

Although for the most part Klein and Isaacs describe phantasies in terms of ‘stories’, for example, ‘I want to eat her all up’, these stories are based upon images:
'What, then, does the infant hallucinate? We may assume, since it is the oral impulse which is at work, first, the nipple, then the breast, and later his mother as a whole person; and he hallucinates the nipple or the breast in order to enjoy it. As we can see from his behaviour (sucking movements, sucking his own lip or a little later his fingers, and so on), hallucination does not stop at the mere picture, but carries him on to what he is, in detail, going to do with the desired object which he imagines (phantasies) he has obtained.' (ibid., p. 86)

The ‘picture’ of the breast that is an image of the instinct makes Isaacs's description of unconscious phantasies virtually identical to Jung's description of the archetype as the ‘self-portrait of the instinct’. When she writes ‘such knowledge [of the breast] is inherent … in the aim of instinct’ (ibid., p. 94), she can be understood to be talking about the same thing that Jung is describing when he states that the yucca moth has an image of the yucca flower and its structure, so that, when present externally, the flower sets off instinctual behaviour (Jung 1919). Both Jung and Isaacs are stating that there is an image of the aim of the instinct—the object that fulfils the instinctual urge—that exists within the psyche, enabling the instinct ‘to know what it is looking for’.

Important differences do, however, exist between Jung and Klein. Klein was a psychoanalyst who extended Freud's concepts of libidinal and destructive instincts to pre-Oedipal development, focusing on how infancy lies at the core of the personality. On the other hand, although Jung drew attention to the inherent richness of the mind before Klein began writing, his interest in childhood and infancy is limited. Although he refers to the individuality of the infant (Jung 1911, 1921), for the most part he thinks that the infant is in primary identity with the mother (Jung 1927). The issue of primary identity raises a number of questions which have since been addressed by Fordham." (pp. 412-413)

Elizabeth Urban (1992). The Primary Self and Related Concepts in Jung, Klein, and Isaacs. Journal of Analytical Psychology, Vol. 37, pp. 411-432

Sunday, September 2, 2012

Sandor Ferenczi's Impact on the Practice of Modern Short-Term Therapy

"Ferenczi's work was far ahead of its time. Certain techniques constituting the therapist's heightened activity level are now established as brief therapy principles and are evident throughout all phases of treatment, from assessment to termination. Davanloo (1978, 1980) and Sifneos (1987), in particular, focus their activity on the persistent challenging of defenses and on anxiety-provoking conflicts respectively. Their models require highly confrontational techniques aimed at stimulating emotions. Together with Malan (1963, 1976, 1979), these authors maintain an active transference approach and seek to bring together the affective and cognitive elements of treatment. The interactive process between patient and analyst is reciprocal and emotionally charged. Mann (1973) adheres to the active analytic position, but he also revives Ferenczi and Rank's concept of enforced termination. He believes that the setting of limits forces a patient to face reality and to give up unrealistic transference expectations.

As practiced by these major proponents of modem short-term therapy, the active transference approach involves increased verbal interaction between the patient and therapist. As Bauer and Kobos (1987) observe, a verbally active therapist is not compatible with a free-associating patient. In psychoanalysis, the therapist maintains a stance of evenly hovering attention and there are few interruptions into the patient's associations. In short-term therapy, the patient's associations are often directed by the therapist to explore specific material relevant to the focus and goals of treatment. For example, if a patient became more defensive when discussing a certain topic, Davanloo would forcefully challenge the patient's resistance. His approach often raises strong affect in the patient, particularly anger. By contrast, a practitioner of long-term psychoanalytic psychotherapy or psychoanalysis would tend to observe the pattern and development of resistance before confronting the patient.

Short-term therapists adhere to a focus on the core conflict and do not permit the patient to digress defensively from this central concern. As a result, the therapist is often confronting, clarifying, and interpreting defenses, thereby increasing the emotional intensity of the session. Since the treatment focus tends to involve issues which are expressed and explored in the therapeutic dyad, the level of emotional involvement is high for the therapist as well.

With the prevailing trend from one-person to two-person psychology, practitioners of short-term therapy generally acknowledge the interpersonal nature of therapy. The therapist is not viewed as a "blank screen" but rather as a coparticipant whose behavior shapes the transference. This approach is consistent with Ferenczi's insights on countertransference as a way to understand the patient's experience. Countertransference themes in short-term treatment often involve guilt and problems tolerating separation and loss. Shafer (1986) notes that brief treatment thwarts the therapists' re-parative need to completely heal the patient, as well as the need to be omniscient and omnipotent. Unlike long-term therapy, Mann (1986) observes that in short-term psychotherapy, therapists do not receive narcissistic gratification in having patients depend on them.

Brief Focal Psychotherapy, established by Malan, emphasizes another aspect of Ferenczi's work, namely concentrating the therapist's effort on analyzing the point at which trauma occurred. Malan, like Ferenczi, did not feel it was necessary to analyze every feature of the patient's mental life. Dealing with selective aspects of the patient's conflict is described in the other models as well. In his practice of Time-Limited Psychotherapy, for instance, Mann focuses on the central issue of the patient's chronically endured pain. Malan and Davanloo focus on the triangle of conflict (wish, anxiety, and defense) and the triangle of. insight (therapist, current relationship, and parent or past figure). Lastly, Sifneos' Short-Term Anxiety Provoking Psychotherapy concentrates on the patient's "circumscribed chief complaint."

The careful selection of patients is also common to the majority of short-term practice models. Given the high level of emotional intensity, patients must be able to benefit from this experience. It is therefore not surprising that these practitioners choose patients who are highly motivated, capable of insight, and able to establish a collaborative relationship with the therapist. These ego resources are necessary to help the patient throughout the arduous and painful treatment process.

Modem short-term therapy is characterized by a high level of commitment on the part of both the patient and therapist. This can also be seen in much of Ferenczi's work. Short-term therapists have had to continually defend their techniques as having been founded on core psychoanalytic principles. They have worked hard to dispel the myth that short-term therapy is superficial and dictated solely by factors extraneous to the patient's interest. Patients often turn to brief treatment as a last resort after other therapies have failed, as did Ferenczi's patients who came from all parts of the world with the hope of being cured.Conclusion

Sandor Ferenczi, a psychoanalytic pioneer and practitioner, suggested changes in psychoanalytic technique which would shorten the length of psychoanalysis. His introduction of "active therapy" involved increased activity from both the patient and analyst as a means to facilitate the exploration of unconscious material. The psychoanalyst prescribed the performance or cessation of certain behaviors, thus instituting active measures which made the patient a full participant in the psychoanalytic process. Interpretation, Ferenczi contended, was an active intervention which interrupted the patient's psychic activity, leading to the uncovering of repressed thoughts and ideas. In collaboration with Rank, Ferenczi underscored the importance of here-and-now transference interpretations and emphasized the emotional experiences of the patient in the transference, rather than the sole intellectual recovery of memories. Ferenczi noted that intellectual discovery without affect can serve as resistance.

Ferenczi's central ideas on active psychoanalytic treatment and interpretation are the cornerstone of modem dynamic short-term treatment. His ideas have been lauded and incorporated into the works of modern short-term therapists, such as Davanloo, Mann, and Sifneos. Ferenczi's emphasis on the importance of present life events in psychoanalytic treatment is currently receiving much attention in the psychotherapeutic community. This can be seen in the emphasis on the treatment of Axis I disorders and symptomatology, as well as the process of maintaining a process in most models of short-term treatment.

Sandor Ferenczi's incessant drive to improve psychoanalytic methodology has provided inspiration to modem short-term therapists. While Davanloo and others have had the benefit of years of development in research, theory, and technique, it was Ferenczi who pioneered these efforts and who served as a role model. His courage and experimental spirit embody the essence of psychoanalytic inquiry, and have, in my estimation, earned him the title of 'Forerunner of Modem Short-Term Psychotherapy'."
(pp. 36-39)

Carol Tosone (1997). Sándor Ferenczi: Forerunner of Modern Short-Term Psychotherapy. Psychoanalytic Social Work, Vol. 4, pp. 23-41