"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
Thursday, September 6, 2012
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
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
Monday, August 20, 2012
Jean Knox - Attachment Theory and Contemporary Jungian Views
"In the introduction I pointed out Jung's interest in dissociation as opposed to Freud's focus on repression as the mechanism whereby material is kept out of consciousness. I will now turn to attachment theory again to discuss the concept of defensive exclusion and its relationship to the formation of internal working models.
I am aware that I have not yet satisfactorily dealt with the question of the discrepancy between events or people in the real world and the representations of those people or events, which often seem such distorted images of the real world. Drive theory accounts for this quite easily with its model of instinctual phantasy, out of which arise internal objects which do not reflect the external world.
However an alternative model can be derived from attachment theory. Separation anxiety is constantly activated in childhood, activating fears of abandonment and annihilation based on the growing child's sense of dependence and vulnerability. Separation, narcissistic and Oedipal anxieties are defended against by omnipotent and grandiose fantasy and experience is filtered through these defences, so that unbearable fears or events are excluded from conscious attention and awareness. However this does not prevent the fears and the defences from being inextricably bound up with the internalized image or memory of the event, so that the defences become part of the schematized patterns which are being formed in implicit memory as well as the events themselves.
The internal working model (or complex) therefore reflects these fears and defences and so may take a very different form from the person or event in the real world; the degree of distortion probably reflects the relative contribution of fear and defensive fantasy to the internal working model. This provides us with an alternative way of conceptualizing unconscious fantasy from that of instinctual drives.
Internal working models which reflect threatening past experience lead to further defensive exclusion of any encounter which activates the schema, so that there is a withdrawal or avoidance of engagement and relationship. This leads to an inability to learn from new experience and a failure to modify the internal working model, which remains encapsulated and split off from the rest of the psyche, just as Jung described complexes being dissociated ‘splinter psyches’.
Conclusion: Internal psychic reality is formed from the internalization of accumulated past experience of key attachment figures and is not an expression of innate instinctual drives. The concept of implicit memory provides us with an experimentally-based account of the way in which experiences are internalized and stored in a generalized schematic form which is not available to recall or conscious awareness, but which patterns our expectations of, and perception of, present attachments and relationships.
These schematized patterns are equated with the internal working models of attachment theory; the contribution of defensive exclusion to the formation of internal working models is discussed. I also suggest that internal working models have many features in common with the Jungian concept of complexes and a new view of complexes is therefore being proposed." (pp. 527-528)
Jean Knox (1999). The relevance of attachment theory to a contemporary Jungian view of the internal world. Journal of Analytical Psychology, Vol. 44, pp. 511-530
I am aware that I have not yet satisfactorily dealt with the question of the discrepancy between events or people in the real world and the representations of those people or events, which often seem such distorted images of the real world. Drive theory accounts for this quite easily with its model of instinctual phantasy, out of which arise internal objects which do not reflect the external world.
However an alternative model can be derived from attachment theory. Separation anxiety is constantly activated in childhood, activating fears of abandonment and annihilation based on the growing child's sense of dependence and vulnerability. Separation, narcissistic and Oedipal anxieties are defended against by omnipotent and grandiose fantasy and experience is filtered through these defences, so that unbearable fears or events are excluded from conscious attention and awareness. However this does not prevent the fears and the defences from being inextricably bound up with the internalized image or memory of the event, so that the defences become part of the schematized patterns which are being formed in implicit memory as well as the events themselves.
The internal working model (or complex) therefore reflects these fears and defences and so may take a very different form from the person or event in the real world; the degree of distortion probably reflects the relative contribution of fear and defensive fantasy to the internal working model. This provides us with an alternative way of conceptualizing unconscious fantasy from that of instinctual drives.
Internal working models which reflect threatening past experience lead to further defensive exclusion of any encounter which activates the schema, so that there is a withdrawal or avoidance of engagement and relationship. This leads to an inability to learn from new experience and a failure to modify the internal working model, which remains encapsulated and split off from the rest of the psyche, just as Jung described complexes being dissociated ‘splinter psyches’.
Conclusion: Internal psychic reality is formed from the internalization of accumulated past experience of key attachment figures and is not an expression of innate instinctual drives. The concept of implicit memory provides us with an experimentally-based account of the way in which experiences are internalized and stored in a generalized schematic form which is not available to recall or conscious awareness, but which patterns our expectations of, and perception of, present attachments and relationships.
These schematized patterns are equated with the internal working models of attachment theory; the contribution of defensive exclusion to the formation of internal working models is discussed. I also suggest that internal working models have many features in common with the Jungian concept of complexes and a new view of complexes is therefore being proposed." (pp. 527-528)
Jean Knox (1999). The relevance of attachment theory to a contemporary Jungian view of the internal world. Journal of Analytical Psychology, Vol. 44, pp. 511-530
Tuesday, August 7, 2012
Irene Ruggiero - The Unreachable Object?
"It is well known that various models exist to explain the genesis and the structure of the borderline disturbance. One model emphasizes the role of aggression and of envy: they are thought to be characterized by an individual, constitutionally determined threshold (the so-called ‘conflict model’ which dates back to Kernberg’s thought). The other model instead gives prominence to a lack of attunement in the primary environment, which is thought to hinder the formation of those internal structures of self-regulation without which it is not possible to reach a sufficient level of cohesion of the self and become autonomous from archaic relationships with the selfobjects (this is the so-called ‘deficit model’ which emerges from the theories of Kohut). These models have led to divergent views about the most important factors in the therapy. In the ‘conflict model’, stress is placed on the steadfastness of the analytic setting (the stability of which reassures the patient that the analyst can contain and survive his destructiveness), and on the instrument of interpretation (this method allows confronting the patient on the issue of his aggression early in the process). However, the deficit model emphasizes above all attention to the ego-attuned subjectivity of the patient, and endorses the provision of the physiological fusion which was missing in the primary relationship.
Several colleagues (including Casement, 1990; Correale and Berti Ceroni, 1997; Modell, 1988; Monari, 1999), who highlight the opportunity to use both approaches, the ‘empathic’ and the interpretative, seeing these as the development of a single original matrix, believe that a sort of treatment in two phases may be particularly useful. In the early phase, the functions of containment, empathic mirroring and support predominate, with the use of interpretation being held back for the second phase.
This position, in which I recognize myself, is also borne out of the consideration that – as is often the case with traumatized people – in borderline individuals, behaviours and fantasies characterized by a certain level of automatism are present, accompanied by a reduction in the capacity to represent and the overdevelopment of the emotional components. In these moments of sensorial over-excitement, interpretative activities carry a risk of overburdening the patient further, who is already caught up in difficulties of mentalization. Meanwhile the activities of presence and connection assume great importance (Correale, 2006).
I share the position of those (Mitchell, 1993) who maintain that aggression, whilst having its own innate individual potential, is activated in relational and environmental situations that are perceived subjectively as being dangerous, a point which explains the particular sensitivity of borderline patients to minimal variations in the therapeutic environment. If, as I think, traumatic factors play an essential role in the genesis and the emergence of borderline functioning, we need to give particular attention to the microtraumas which can come about in the consulting room and to anti-therapeutic factors which can be attributed to the analyst’s difficulties (Ferenczi, 1932), as well as those activated by the difficulties of the patient. The specific contribution of my work consists in exploring the nature and possibility of using the countertransference in the game of symmetry and asymmetry which is created between the unconscious of the patient and the analyst. This is a game which works, more specifically, when the transference does not only manifest itself through words.
With borderline patients, in whom extensive areas remain unavailable to representation, it is necessary to work at length to cement a narcissistic tissue which is rather frayed. Before being able to use interpretative instruments, it is often necessary to undertake a long piece of analytic work which facilitates the transformation of as yet non-representable elements into representations that can be thought, dreamed and expressed in words.
One of the most specific difficulties that the analyst must confront in this work is the intense amount of destructiveness that these patients bring and activate. Whether this is determined by constitution or whether it represents the outcome of deficient primary relationships, the containment of the – sometimes raging – aggression of the borderline patient constitutes an unavoidable technical knot and a hard test for the analyst. Personally, I share the belief that it is fundamental to provide these patients with the potential to test the analytic setting as trustworthy and authentically containing before interpreting their intense destructiveness, which is often not yet available to thought." (pp. 586-587)
Irene Ruggiero (2012) The Unreachable Object? Difficulties and Paradoxes in the Analytical Relationship with Borderline Patients, International Journal of Psychoanalysis, Vol. 93, pp. 585–606
Several colleagues (including Casement, 1990; Correale and Berti Ceroni, 1997; Modell, 1988; Monari, 1999), who highlight the opportunity to use both approaches, the ‘empathic’ and the interpretative, seeing these as the development of a single original matrix, believe that a sort of treatment in two phases may be particularly useful. In the early phase, the functions of containment, empathic mirroring and support predominate, with the use of interpretation being held back for the second phase.
This position, in which I recognize myself, is also borne out of the consideration that – as is often the case with traumatized people – in borderline individuals, behaviours and fantasies characterized by a certain level of automatism are present, accompanied by a reduction in the capacity to represent and the overdevelopment of the emotional components. In these moments of sensorial over-excitement, interpretative activities carry a risk of overburdening the patient further, who is already caught up in difficulties of mentalization. Meanwhile the activities of presence and connection assume great importance (Correale, 2006).
I share the position of those (Mitchell, 1993) who maintain that aggression, whilst having its own innate individual potential, is activated in relational and environmental situations that are perceived subjectively as being dangerous, a point which explains the particular sensitivity of borderline patients to minimal variations in the therapeutic environment. If, as I think, traumatic factors play an essential role in the genesis and the emergence of borderline functioning, we need to give particular attention to the microtraumas which can come about in the consulting room and to anti-therapeutic factors which can be attributed to the analyst’s difficulties (Ferenczi, 1932), as well as those activated by the difficulties of the patient. The specific contribution of my work consists in exploring the nature and possibility of using the countertransference in the game of symmetry and asymmetry which is created between the unconscious of the patient and the analyst. This is a game which works, more specifically, when the transference does not only manifest itself through words.
With borderline patients, in whom extensive areas remain unavailable to representation, it is necessary to work at length to cement a narcissistic tissue which is rather frayed. Before being able to use interpretative instruments, it is often necessary to undertake a long piece of analytic work which facilitates the transformation of as yet non-representable elements into representations that can be thought, dreamed and expressed in words.
One of the most specific difficulties that the analyst must confront in this work is the intense amount of destructiveness that these patients bring and activate. Whether this is determined by constitution or whether it represents the outcome of deficient primary relationships, the containment of the – sometimes raging – aggression of the borderline patient constitutes an unavoidable technical knot and a hard test for the analyst. Personally, I share the belief that it is fundamental to provide these patients with the potential to test the analytic setting as trustworthy and authentically containing before interpreting their intense destructiveness, which is often not yet available to thought." (pp. 586-587)
Irene Ruggiero (2012) The Unreachable Object? Difficulties and Paradoxes in the Analytical Relationship with Borderline Patients, International Journal of Psychoanalysis, Vol. 93, pp. 585–606
Thursday, August 2, 2012
Hans Dieckmann - Fairytales in Analysis
"Such a favourite fairy-tale could be found in the unconscious of most of the patients I treated over a long period. Not all of them have been common fairy-tales. There were a lot of not so well-known ones from Andersen, Hauff, Brentano and others, and, also, though seldom, stories from modern children's books like Winnie-the-Pooh, Alice in Wonderland, etc. In most cases this material was more or less repressed in the unconscious.
If you ask the patient during the first session you usually get one of the common traditional fairy-tales remembered at that moment, such as Cinderella, Snow-White and the Seven Dwarfs, or Little Red Riding Hood, as the investigations of Wittgenstein (1955) have shown. The really individual favourite fairy-tale will emerge from the unconscious for the first time after some regression into the early childhood has taken place. Sometimes a dream symbol will give the first hint of it, sometimes the associations of the patient during a certain period of childhood. To my own astonishment this material was very individualistic. Among the 50 patients the same tales have been found only two or three times.
It is hardly surprising that one should find, at least in most European patients, a favourite fairy-tale from childhood. As a rule, such tales are among the earliest cultural products taken up by the human soul. In this way the typical imaginings of the culture can be assimilated and the structures of the archetype per se filled out with forms and pictures. On the other hand the main fairy-tale period of childhood is also the time when fundamental neurotic patterns are formed and the first neurotic symptoms come into existence. So we may have here a very important point: that the fairy-tale can tell us something about the basic structure and dynamics of the individual neurosis. It may also show us the organization of ideas and experiences of archetypal forms (Dieckmann, 1967). The partial or total identification of the ego with an archetypal image as the nuclear charge of a complex is one of the principal criteria of neurosis.
On the other hand the healthy ego-complex will only have such identifications in a passing way (Jacobi, 1942). So it is reasonable that we should also find such fixed identifications if the favourite fairy-tales of childhood return to consciousness during the course of analytical treatment. In practice one finds in this way many comparisons between the themes or symbols of the fairy-tale and the symptoms of neurosis." (pp. 22-23)
"It seems to me that a real understanding on the symbolic level of the solution of the problem in the fairy-tale is of great importance also for the analyst. All fairy-tales include individuation processes as is shown by many authors (v. Franz, v. Beit, Jaffé, Dieckmann, Laiblin and others) and they show in a symbolic form different ways of psychic growth and progress. So it may be possible to translate them in a behaviouristic way and to understand them on the objective level. This will lead to complications, because in this case the analyst will unconsciously accept the identification of the patient's ego with the image of the archetype." (p. 28)
"In a large number of patients favourite fairy-tales arise from the unconscious in connection with dreams, fantasies or associations. The main fairy-tale time of childhood is the time in which fundamental neurotic patterns are laid down and the first neurotic symptoms appear. There is a strong connection between these fairy-tales and the symptoms of the later neurosis, the structure of the personality and the patterns of behaviour. Such correlations have been investigated in 50 patients. Examples are presented in this paper.
Fairy-tales are among the earliest cultural products absorbed by the human soul. In this way the typical images of the culture can be assimilated and the structure of the archetype per se filled out with forms and pictures. Therefore the fairy-tale can be used as a diagnostic tool for the determination of the neurotic archetypal fixation.
The material shows the therapeutic value of bringing these images into consciousness and working them through at a symbolic level." (p. 29)
Hans Dieckmann (1971). The Favourite Fairy-Tale of Childhood. Journal of Analytical Psychology, Vol. 16, pp. 18-30
If you ask the patient during the first session you usually get one of the common traditional fairy-tales remembered at that moment, such as Cinderella, Snow-White and the Seven Dwarfs, or Little Red Riding Hood, as the investigations of Wittgenstein (1955) have shown. The really individual favourite fairy-tale will emerge from the unconscious for the first time after some regression into the early childhood has taken place. Sometimes a dream symbol will give the first hint of it, sometimes the associations of the patient during a certain period of childhood. To my own astonishment this material was very individualistic. Among the 50 patients the same tales have been found only two or three times.
It is hardly surprising that one should find, at least in most European patients, a favourite fairy-tale from childhood. As a rule, such tales are among the earliest cultural products taken up by the human soul. In this way the typical imaginings of the culture can be assimilated and the structures of the archetype per se filled out with forms and pictures. On the other hand the main fairy-tale period of childhood is also the time when fundamental neurotic patterns are formed and the first neurotic symptoms come into existence. So we may have here a very important point: that the fairy-tale can tell us something about the basic structure and dynamics of the individual neurosis. It may also show us the organization of ideas and experiences of archetypal forms (Dieckmann, 1967). The partial or total identification of the ego with an archetypal image as the nuclear charge of a complex is one of the principal criteria of neurosis.
On the other hand the healthy ego-complex will only have such identifications in a passing way (Jacobi, 1942). So it is reasonable that we should also find such fixed identifications if the favourite fairy-tales of childhood return to consciousness during the course of analytical treatment. In practice one finds in this way many comparisons between the themes or symbols of the fairy-tale and the symptoms of neurosis." (pp. 22-23)
"It seems to me that a real understanding on the symbolic level of the solution of the problem in the fairy-tale is of great importance also for the analyst. All fairy-tales include individuation processes as is shown by many authors (v. Franz, v. Beit, Jaffé, Dieckmann, Laiblin and others) and they show in a symbolic form different ways of psychic growth and progress. So it may be possible to translate them in a behaviouristic way and to understand them on the objective level. This will lead to complications, because in this case the analyst will unconsciously accept the identification of the patient's ego with the image of the archetype." (p. 28)
"In a large number of patients favourite fairy-tales arise from the unconscious in connection with dreams, fantasies or associations. The main fairy-tale time of childhood is the time in which fundamental neurotic patterns are laid down and the first neurotic symptoms appear. There is a strong connection between these fairy-tales and the symptoms of the later neurosis, the structure of the personality and the patterns of behaviour. Such correlations have been investigated in 50 patients. Examples are presented in this paper.
Fairy-tales are among the earliest cultural products absorbed by the human soul. In this way the typical images of the culture can be assimilated and the structure of the archetype per se filled out with forms and pictures. Therefore the fairy-tale can be used as a diagnostic tool for the determination of the neurotic archetypal fixation.
The material shows the therapeutic value of bringing these images into consciousness and working them through at a symbolic level." (p. 29)
Hans Dieckmann (1971). The Favourite Fairy-Tale of Childhood. Journal of Analytical Psychology, Vol. 16, pp. 18-30
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