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Journal of the American Psychoanalytic Association


McWilliams, N. (2016). Training Analysts at William Alanson White. Journal of the American Psychoanalytic Association 64(4):NP12. (Original doi: 10.1177/0003065116667506)

Freud and Schnitzler-(Doppelgaunger)

Most Frequently Read Articles - ven, 2016-11-04 01:00
Herbert I. Kupper, Hilda S. Rollman-Branch
Jan 1, 1959; 7:109-126

Masochism and its Rhythm

Over five years, from 1919 to 1924, Freud dealt with masochism in three texts written in close proximity: "A Child Is Being Beaten," Beyond the Pleasure Principle, and "The Economic Problem of Masochism." Initially Freud explains masochism as incestuous fixation on the father and regression to pregenital, sadistic ways of loving. Subsequently he considers it primarily as subservient to the death drive. This paper starts from an idea present in two of the three texts, but not developed by Freud, in which he refers to the role that the "qualitative" element of rhythm could play in the occurrence of pleasure in masochism. By means of this element traumatic aspects of the primary relationship with the object could be stored as fantasies in the body. In any staged masochistic fantasies of being beaten or in masochistic perversion, the pleasure of pain would lie in the attempt to "dream" the trauma not only in the imagination but also, "aesthetically," in the body.

Obsessionality: Modulating the Encounter with Emotional Truth and the Aesthetic Object

Experiences with autistic and primitive mental states have significant implications for our understanding of obsessionality. Consequently, obsessionality is seen as an attempt at a massive simplification of experience, in order to deal with the pain inherent in the encounter with intense emotional experience and with the separateness of an enigmatic object that eludes one’s omnipotent control. Moreover, early loss and a precocious awareness of separateness often play roles in the withdrawal to obsessional thinking and verbosity, and to an illusion of omnipotent control of the object. Interpretations focusing on conflicting desires, or linking repressed and displaced parts of the personality with the defenses against them, do not reach these patients in a way that facilitates psychic change. An alternative approach, it is suggested, is to work at primitive, nonsymbolic levels of mental functioning, where experience cannot be verbally communicated and dynamically interpreted, but must first be lived in the here and now of the analysis. This is illustrated through the analysis of a person trying to cope with the experience of early loss by deadening emotion and finding shelter in obsessionality.

Finding Control Cases and Maintaining Immersion: Challenges and Opportunities

Given that surveys, as well as frequent observations by institute faculty, indicate that many candidates have difficulty finding control cases and maintaining immersion and that many graduate analysts face similar challenges, it would seem that psychoanalytic training does not prepare candidates adequately for finding patients and practicing analysis while in training and, for many, after they have graduated. Although external challenges are formidable, it is by identifying and making use of internal challenges to finding cases that candidates can develop an analytic mind: the identity, approach, and skills necessary not only to graduate but to have the choice to practice clinical psychoanalysis post-graduation. Some of the internal challenges and their manifestations in different phases of initiating analysis (referrals, initial consultation, recommendation) are discussed and two detailed examples are offered to illustrate the productive use of candidates’ countertransferences in finding cases and maintaining immersion. Finally, recommendations for institutional solutions are provided.


Most Frequently Read Articles - lun, 2016-10-03 00:00

Oct 3, 2016; 0:306511-306511

Masochism and its Rhythm

Most Frequently Read Articles - sam, 2016-10-01 00:00
Giuseppe Civitarese
Oct 1, 2016; 64:885-916

Changes in Self-Representations Following Psychoanalytic Psychotherapy for Young Adults: A Comparative Typology

Most Frequently Read Articles - sam, 2016-10-01 00:00
Andrzej Werbart, Lars Brusell, Rebecka Iggedal, Kristin Lavfors, Alexander Widholm
Oct 1, 2016; 64:917-958

"Unavoidable Satisfactions": The Analysts Pleasure

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.

The Relevance of Bionian Thinking to the Treatment of PTSD Patients

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.

Can Babies Remember Trauma? Symbolic Forms of Representation in Traumatized Infants

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.

Working Through the "Caesura": A Clinical Illustration

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.

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