International Journal of Psychoanalysis最新文献

This paper examines the characteristics and clinical utility of the psychoanalytic field theory proposed by M. and W. Baranger, with particular emphasis on the issues of the transferential-counter transferential relationship and the 'second look'. The role of central key metaphors embodied in the experience of both patient and analyst is illustrated through the author's personal experience and participation in Three Level Model (3LM) work groups. The risk of moments of intense communication between patient and analyst has the possibility for the analyst to lose distance, making it necessary to go beyond moments of emotional resonance and reverie and to take a "second look" to understand the analyst's involvement in the interactional process in order to prevent the constitution of bastions of the field. The 3LM work groups extend the temporal context to include longer periods of time and a "third group look" that triangulates perspectives through group discussions, allowing for the exploration of transformations that have occurred in the analysis. The field perspective contributes to a deeper understanding of the transference-countertransference relationship. The "second" and the "third look" broadens the analyst's insights and enriches the understanding of the psychoanalytic process and its multifaceted dynamics.

The aim of this paper is to report the partial results of an exploratory investigation into how twelve psychoanalysts of different theoretical-clinical orientations perceive and use hypotheses about the phenomena of change in connection with selected material from a psychoanalytic treatment. The Three-Level Model (3-LM) was used for the observation of patient transformations and for the collection of data. This was followed by the statistical analysis of the behaviour and relationship of a set of variables relating to the type and degree of change perceived in the patient's mental functioning during the course of her treatment. The results reported here show that there was significant agreement among the participants, irrespective of their theoretical-clinical orientation, as regards the following: 1) the positive impact of the application of psychoanalytic treatment in diverse areas of the patient's mental functioning; 2) the explanatory hypotheses of the changes observed in the patient under consideration; 3) the usefulness of the experience of group exchange using the 3-LM in observing and understanding the changes in the patient.

This paper describes the work of a psychoanalyst working within NHS mental health services in the UK . The central contribution of a psychoanalytic approach within psychiatric care in offering a committed attempt towards understanding the patients' presentation, rather than treatment primarily aimed at symptom control, is described. Beyond this, the specific contribution of psychoanalytic ideas in establishing a containing framework for staff, and how this strengthens the capacity of the organisation as a whole to contain anxiety and to metabolize complex projective processes is outlined. Examples are given with clinical illustrations of activities which enhance this capacity in ordinary times.The author then turns to the impact of the covid-19 pandemic upon staff and patients, describing how fear, threat and experiences of multiple losses have permeated all areas of our lives and activated primitive defences. The pandemic starkly revealed profoundly disturbing questions about our assumptions and habits, adding to the intensity and multi-layered quality of the anxieties evoked . Urgent attention has been drawn to our deeply problematic relationship with the natural world, our own habitat, and indefensible social inequities have been crudely exposed. Staff have been caught between their own fear, the need to contain increased disturbance in their patients, already struggling with fragmented and disordered states of mind, and pressures from an organisation under intense strain. The capacity of mental health staff to act as containers for their patient's distress has been profoundly challenged and compromised.This paper outlines how the pandemic has highlighted the crucial role of the organisation as a container for anxiety and in supporting staff to do their work in mental health care. In order to strengthen this capacity during the crisis, the author describes how ideas derived from psychoanalytic principles were developed into guidance for NHS Mental Health Trusts during the early days of the pandemic . This guidance was adopted nationally by the Royal College of Psychiatrists and is summarised in this paper.

Transference interpretation has always been regarded as very important to psychoanalytic practice. However, analysts differ on its centrality relative to other forms of intervention. This paper argues that transference interpretation as introduced by Freud and then taken up and developed by Klein ("transference interpretation proper") is, in fact, the only form of intervention that could bring about essentially analytic change. To understand why, a taxonomy of different forms of intervention commonly practiced within the analytic situation is presented, including interventions that relate to transference, but do not constitute transference interpretation proper. The latter kind is then described in detail. Next, the paper defines analytic change. It relies on a particular perspective on what it is to come to know psychic truth; one that sees such knowing as a lived state of mind, rather than a state of having knowledge about one's dynamics. This foundational Freudian perspective has been especially advanced through Klein's notion of phantasy. Given this view of analytic change it becomes clear that it can only be brought about through transference interpretation proper. The paper also addresses reasons why it seems especially difficult to embrace this view in contemporary psychoanalytic culture, while stressing how crucial it is to do so.

In this paper, the authors explore the depiction of perversion and the associated interplay of life and death drives in Roman Polanski's 1992 film Bitter Moon. To begin with, a theoretical discussion is presented regarding perverse organizations of mastery and sadomasochism. Perversion is viewed as an expression of the death drive under erotic disguise, in which the destructive fingerprint of the death drive is revealed at every stage, having as its ultimate purpose the destruction of the other. Based on these theoretical insights a dialogue is developed with Polanski's film, which brings to life the theory of sadomasochistic relations through the multidimensional aesthetic medium of cinema. It is shown how Polanski's cinematic oeuvre conveys the essence of the difficult and complex experience of perverse relations, where the life and death drives and their transformations are manifested. The portrayal of the sadomasochistic relations in this film contributes to the experiential knowledge with which the authors promote insight that would potentially enrich the clinical work with patients with perverse organizations.

This brief introduction gives an historical outline of the development of the concept of transference in the different psychoanalytic traditions. It goes back to the various meanings of the German term "Übertragung" - transference, transcription, transmission, transposition and assignment - and how they were accentuated by the different psychoanalytic schools. The paper depicts the transition from a mainly intrapsychic understanding of transference as repetition to a more bipersonal and intersubjective approach exploring the different meanings of "intersubjectivity" and the forces that operate within the analytic field. Major developments arose from a new understanding of the role of the analyst's countertransference and the detection of transference mechanisms in narcissistic, borderline and psychotic states. The exploration of different forms of splitting and projective and introjective identification deepened the understanding of the analytic communication and led to concepts like "acting in", role-responsiveness, "actualization" and "enactment". As the author tries to show, all these approaches can find a legitimization in Freud's original writings, but the main differences concern technical issues, i.e. the interpretation of transference.

Besides the symbolic unconscious, psychoanalysis today investigates unconscious structures that are dissociated from mental functioning (Lombardi 2017) and encoded in bodily inscriptions. These bodily configurations often stay outside of the psychoanalytical attention and technique of treatment. Two concepts - encapsulated body engrams and somatic narration - provide a theoretical and technical proposition for the bodily encoded unconscious. Within this frame, the paper focuses on new aspects. It is outlined that the encapsulated body engrams result from a traumatic disorganization of the primal relation to the caregiver leading to an impossibility of a separation from the mother's body. Separation is now feared as a deadly fall into an endless abyss. However, this element is no longer viewed as an unconscious phantasy that can be interpreted but as the perception of a disorganized bodily syndrome that must be worked through with a considerable reverberation-time (Birksted-Breen 2009) in a body-to-body dialogue. Somatic narration encourages the patient to describe his painful bodily perception and invites the body-self to show up during the analytical encounter. Working this way allows the patients disorganized body-self to slowly develop into a container to harbor, organize and symbolize emotions. Four clinical examples illustrate this manner of working.

This article explores the reception and response of the psychoanalytic community to attachment theory by reviewing articles, with 'attachment' as a keyword, published up until December 2020 in the top seven (according to impact factor) English-language psychoanalysis journals in the ISI Web of Knowledge. A category system was designed and applied to classify the articles which met the inclusion criteria.Since 1996, there has been a significant increase in publications that compare attachment theory and psychoanalysis, explore avenues of integration, analyse different theoretical and technical aspects, or make eclectic use of concepts from both models. Overall, however, few articles referring to attachment (246, representing 1.8% of the sample) have been published in the analysed journals, and of those, many hardly make any mention of psychoanalysis.Contributions by the attachment theory pioneer, John Bowlby, emerged from psychoanalytic practice, with attachment theory reinforcing the more relational approaches of psychoanalysis. Nonetheless, a main conclusion of our study is that attachment and psychoanalysis follow parallel or divergent paths.