International Journal of Psychoanalysis最新文献

Randomized controlled trials have reported psychoanalytic psychotherapy to improve longer-term post-treatment outcomes in patients with treatment-resistant depression. In this case study, we examine the therapy process of a female trial participant diagnosed with treatment-resistant depression. Structured clinical assessments indicated that the patient's level of depression remained unchanged during and after treatment. Over the course of the therapy, she repeatedly broke away from important others and finally also from the therapy itself, which we linked to the impact of earlier experiences of abandonment on her internal world. In the discussion, we present a variety of reflections that were put forward by the authors during a series of case discussion meetings. Some of these reflections relate to how the inner world of this patient might have triggered a negative therapeutic reaction and a destructive pattern of repetition. The interpretative stance, in which the therapist interpreted this reaction as indicative of a psychic conflict and linked this conflict to the therapeutic relationship, seemed to be experienced by the patient as unhelpful and persecutory. Other elements that were brought up include basic distrust, lack of symbolization and trauma in the patient, as well as the constraints of the research context.

This Analyst at Work section examines the work of an older psychoanalyst as he ages yet continues to work as a psychoanalyst. Eike Hinze describes his work with a disturbed young man. Decisions about starting an analysis and the struggles involved in 'reaching' this patient form part of the question of whether this is a 'quest', or another analysis, near the end of an analytic career.Of particular note is Dr. Hinze's explicit use of his own 'reverie'/ countertransference/ unconscious states to form interventions. The two discussants express their own understanding of how they might approach the problems posed. They both speak to the forms of intervening that differ from their own, and their clinical understanding of revealing one's own associations in the clinical hour. They also speak to how the process of aging might have influenced the clinical work itself.The possible shift in technique over the course of Dr. Hinze's clinical career is more difficult to assess: does it come from age, maturity, shifts in theory and technique, or an intense desire to make emotional contact within this particular patient and clinical setting? These are the "question marks" conveyed in their discussions, like the one in the title itself.

This paper explores the mechanisms that lead to a destructive tendency in the formation and functioning of the psychic apparatus, to the characteristic states of subjects who are drawn to non-life. The dynamics of the primary mother-child relationship involve a structural interaction between mind and body, subject and object. The dialectic between the life drive and the death drive is conceptualized as the structuring of homeostatic dynamic equilibria, in which both drives belong to the living, provided they are kept in a non-isolated system. This conception has analogies with other disciplines that have changed their paradigms, such as neurobiology, which, for living beings in open systems, hypothesises a continuous interconnected Becoming of undivided separation and of discontinuity. In unitary psyche-soma functioning, a dynamic homoeostatic balance marks the state of health of the relating subject; or if, instead, the system is isolated, a pathological dysregulation depending on the emotional-affective vicissitudes it undergoes. Two clinical cases illustrate these dynamics. For this tendency on the level of the somatopsychic unit, the name alloiosis has been put forward, in analogy with cellular apoptosis.

Death and mourning are being shaped by posthumous opportunities for the dead to affect current life in ways not possible in pre-digital generations. The psychological and sociological impact of the dead 'online' and of 'grief tech' is only beginning to be understood. It has not yet been explored psychoanalytically until this paper that examines one type of grief tech, namely the griefbot. This development is critically explored through a psychoanalytic reading of an episode of Black Mirror. I suggest that a psychoanalytic model of mourning provides an invaluable perspective to help us to think about this technology's potential as well as the psychological and ethical risks it poses. I argue that the immortalisation of the dead through digital permanence works against facing the painful reality of loss and the recognition of otherness, which is fundamental to psychic growth and to the integrity of our relationships with others. Drawing on Derrida's conceptualization of 'originary mourning', I suggest that mourning is an interminable process that challenges us to preserve within the self the otherness of the lost object. The tools we use for mourning need to be assessed first and foremost against this psychological and fundamentally ethical process.