Psychoanalytic Review最新文献

The therapeutic encounter with psychotic patients presents therapists with moments in which they may regress, together with the patient, toward primitive and psychotic areas of experience. Within this shared psychotic world, therapists might feel persecuted, as if the ground is slipping from beneath their feet. The author suggests that the psychotic part of the personality, as argued by Bion, is inherent to all of us and may come alive in the psyche of the therapist in response to patients in psychotic states. The psychotic dialogue that emerges between patient and therapist, which involves projective identification and counter-transference mechanisms, must be worked through. Therapists' capacity to survive the psychosis forced upon them and to move through and beyond it is highly significant. By examining clinical material from therapy with a patient diagnosed with schizophrenia, the author discusses this unique countertransference phenomenon, which he terms induced psychotic countertransference.

Freud's mature theorizing about human morality entrenched the functioning of the superego in anxiety stemming from the fear of punishment, a view with which many later psychoanalysts took issue, producing a debate as to the distinction between superego and conscience. This debate would later be mirrored more broadly in academic psychology concerning distinctions between shame and guilt. This is an area where the clinical observations and theoretical discussions of psychoanalysis have subtly guided research in cognitive psychology and the cognitive and affective neurosciences. These areas, in turn, have both clarified and supported psychoanalytic theory and practice without negating the rich phenomenological and theoretical basis on which psychoanalysis rests.

Two decades ago, Adrienne Harris published "Gender as a Soft Assembly," a refreshing, far-reaching paper that intertwines both traditional and cutting-edge psychoanalytic gender theory with anecdotes from Harris's own life as a tomboy in the 1970s. In broadening staid models of development, "Gender as a Soft Assembly" provides the potential for freedom, fluidity, and creativity as an antidote to the rigid, binary constructions of masculinity and femininity. In response, I've summarized the most striking aspects of her paper that coincidentally commingle with my having been a tomboy and offer an opportunity for a reconsideration of my own history.

The authors explore the value of using psychoanalysis in a community and a social justice setting. A so-called Mental Health Marathon Project in South Africa left human wreckage in its wake. Psychoanalysis, as a conjunction between ordinary human interaction and psychoanalytic awareness (Parsons, 2007), provided a way of thinking and intervening in this context so that the families were provided with holding and containment, but forensic goals were also achieved in the form of an expert report. This document, named the "Brick Mother Report" (Steiner, as cited in Rey, 1994), attempts to make psychological sense of the impact of the Marathon Project.

Working through the different faces and vicissitudes of the death drive in the countertransference, and especially through projective identification, is a very challenging process. A thorough and versatile process of containment and working through of the manifold threatening expressions and influences of the death drive is required, experienced most specifically and deeply in the arena of projective identification. This paper demonstrates how each aspect that unfolds in the analyst's countertransference sheds light on a particular layer of anxiety and internal object relations related to it. The creation of a new meaning to the differing expressions of the death drive gradually lessens the compulsion to repeat and enables a better integration between the life and death drives. This process will be illustrated by a prolonged clinical case that involved intense internal working through of the death drive in the analyst's countertransference.

Working with suicidal patients requires that the therapist not be afraid of threats or gestures. The therapeutic partnership requires the patient to stay alive until the next session. Any suicidal gesture will trigger the end of this treatment on the grounds that the patient has shown the treatment was not good enough. Twelve dangerous, neurotic beliefs driving suicidal actions are examined in concert with twelve interventions aimed at dismantling their power over the patient.