International journal of psychoanalytic psychotherapy最新文献

This paper discusses some aspects of the development of the professional self-image and related efforts to maintain self-esteem that appear to be generic to the formal years of clinical training. The phenomenology of training, in particular the changing representations of the professional self and the relationships with supervisors, patients, and peers, is explored within the context of the clinical study of narcissism. A central affective issue in training is the emergence of and the recovery from a significant depressive experience organized around a sense of helplessness and hopelessness of achieving core professional aspirations. The impact of a professional mourning process on the trainee's learning and clinical work is discussed, and relevant supervisory processes are presented.

This paper is based on the empirical evidence that social and sexual deviancy in young persons often succeed on one another, alternate repeatedly, or occur concomitantly. The role of the superego and the relationship of acting out and symptomatic acts to both conditions are explored. States of excitement, tension, and discharge in young persons are described. The scanty but important literature on excitement is reviewed, and the role of this affect in the causation of both deviances is examined in some detail. The occurrence of early fantasies associated with (primary) excitement on a background of early psychic disturbance and environmental failure, common to both deviations, is compared with excitement in later stages of development. The fantasies that accompany physiological and psychological changes at puberty and adolescence provoke arousal and excitation, which is defended against with boredom and depression, which in turn leads to a search for (secondary) excitement. This process is illustrated by several clinical examples drawn from case material of patients treated with psychotherapy and psychoanalysis. Finally, the implications for treatment of a unified approach to the problem of social and sexual deviancy in young people is briefly explored.

This paper describes a patient whose termination phase of analysis activated an intense mourning reaction that helped to overcome the stalemate of therapy. After I attempted to demonstrate how her narcissistic armouring yielded when the termination of analysis was agreed upon, the psychological reenactment of a split off (disavowed) trauma of an early loss (her father) and the failure of essential attributes in maternal care became manifested behind her narcissistic defenses. The reconstruction of these events was possible during the process of mourning. At the termination phase she behaved as if she "had lost the war"; from the point of view of her masochism it was a Pyrrhic victory, "a victory through defeat". Contrary to mother, I let her go but then she refused to go, which created a situation that activated a profound mourning reaction leading to important structural changes. A review of the pertinent psychoanalytic literature on termination along with clinical material derived from the termination phase of a patient with a narcissistic personality is presented.

The basic sources of anxiety and danger experienced by psychotherapists and psychoanalysts in their work with patients are examined. Psychotherapy and psychoanalysis, since they are on a continuum, will be used interchangeably in this paper. Among the sources of such danger are the therapist's use of the two most basic interventions as required by the therapeutic needs of the patient: interpretations and securing the ground rules or framework of the ideal treatment situation and relationship. It is proposed that the present standards of interpretation and ground rules, as they characterize current psychotherapeutic practice, have been fashioned in significant measure by needs within psychotherapists to defend against their own anxieties related to the emergence and realization of their own madness within the course of a therapeutic interaction with a patient.

Although it is generally believed that doctors do not treat their own children, the practice is commonplace. This paper presents the unconscious reasons for the discrepancy between this popular belief and actual practice. The effects of this intrusion on the usual parent-child relationship are discussed. Except in emergency, the doctor's decision to take his own child as a patient is explained as a partial reenactment of the doctor's childhood "doctor game," now shared and acted out in cooperation with his spouse. This special treatment arrangement, which serves to displace reactivated or unresolved unconscious conflict onto the child appears to have far-reaching effects on the child's developing ego and character structure. Attention should be paid to it as a transference phenomenon in the treatment of doctor's children. Relevant literature is reviewed, Freud's personal involvement with the matter is traced, and clinical examples are provided.

W. R. Bion (1952) has pointed out a connection between alterations in the development of the "apparatus for thinking thoughts" and psychosomatic symptoms. Many authors have used this insight, from their own points of view, as a basis for describing this deficiency in thought and in the capacity to formulate images related to the development of psychosomatic symptoms (Krystal & McDougall 1979; Segal, 1950, 1958). This paper applies this hypothesis to a clinical case in which special emphasis is given to the symbolic deficiency, its effect on transference-countertransference, and its relation to falsification, "hyposymbolization," and to a specific phenomenon that could be called "hypersymbolization," in which many meanings are embodied in the same symbol.