Agrégateur de flux

Analysts have often described their work as depriving, painful, and hard to endure, while its pleasures have been the subject of little commentary. The real history and ongoing temptations of boundary violation long ago made the gratifications of psychoanalytic work a matter of anxiety. Analysts’ pleasure in their work was problematized. Some of this problematizing is necessary because of real risk, but much of it is not only unnecessary but misleading and destructive. Psychoanalysts pursue achievement of a unique form of human intimacy, yet acquired habits of professional modesty and humility have encouraged the illusion that analyzing can occur without desire or ambition on the analyst’s part. These habits have made it difficult for analysts to openly discuss what they get from the intimacy of analyzing that yields its pleasures. Our field demands that analysts deny that the work provides much more than pain (at least until the conclusion of an analysis), but psychoanalysis both misunderstands and misrepresents itself if we cannot speak of the distinctly broad range of pleasures available in analyzing.

Analysts who conduct trauma-focused treatments have much to learn from Wilfred Bion’s contributions to the understanding and treatment of PTSD. Concepts such as catastrophe and catastrophic change can illuminate the subjective experience of PTSD patients, the beta screen concept sheds light on dissociative phenomena, and, as shown in a clinical vignette, the analyst can use his alpha function to transform the patient’s fragmented raw material into alpha elements. A second clinical vignette shows how during a cognitive intervention the analyst can impart this alpha function to the patient and use his reverie to help the patient assimilate previously intolerable fragments into a coherent narrative. Finally, the idea of knowing mental pain (Bion’s K) is discussed in relation to the processing of traumatic memories.

Three important areas of current inquiry concerning early trauma—the respective roles of reality and fantasy, age-related capacity for the symbolic representation of trauma, and attachment status—are approached through clinical case reports of three children seen initially at very early ages. The findings are relevant to the issue of whether preverbal infants can experience traumatic events that later are available to interpretation. The focus is for the most part on event traumas—single harrowing, life-threatening experiences—occurring at quite early ages. Three main points are emphasized. First, toddlers and infants (including neonates) can experience intense pain and show symptoms of traumatization. They are capable of experiencing an event as harrowing and life-threatening. Second, these events are capable of being memorialized or symbolically represented, that is, stored in memory in a way that can affect later behavior and learning. Third, how that traumatization resolves itself, or fails to, can be decisively affected by the functioning of the attachment system.

More and more often analysts work with patients who must develop the capacity to participate in analysis. One such patient, H., conveyed the impression of being "bogged down." He did not work or study, and at home with his family was prone to violent outbursts; his social relationships were centered around drug use. Concepts from Bion and Winnicott helped H.’s analyst take the risks necessary to create a therapeutic relationship with him. The patient has come to realize the worth of analytic thinking, and its potential to transform his life. Deviance with respect to technique, and collusion between the narcissistic areas of therapist and patient, pose the risk of dangerous slips in the direction of analytic "omnipotence." Reclaiming the term collusion (from the Latin con-ludere, "to play together"), however, can allow analysts to remain faithful to Freud’s ideas while maintaining a necessary flexibility vis-à-vis the patient. This ludic space can be expanded through Bion’s ideas, which deconstruct a perspective through which we are able to observe "facts," with particular reference to what occurs in the psychoanalytic situation.