Mark Winborn's Blog, page 16
September 18, 2012
Donnel Stern - Dissociation and Understanding
"All understanding is context dependent, and one of the most significant contexts for clinical purposes is the self-state. How we understand the other, and ourselves, depends on the state(s) we occupy. Dissociations between an analyst's self-states can, therefore, limit or impede understanding of the analysand by depriving the analyst of a fitting context within which to grasp what the analysand says and does. Clinical understanding may require the breach of such dissociations...The claim that all experience is continously constructed does not contradict our everyday recognition that some meanings are remarkably enduring. It is entirely consistent with the idea that we continuously create our experience anew to suggest that in some cases we construct the same meaning, or the same pattern in experience, over and over again. To put the point in conventional psychoanalytic language: unformulated experience can be highly structured—though never so structured that multiple interpretations are excluded. Even those structured meanings, though, remain processes. Even the most highly organized unformulated meanings are therefore not static objects or ruts worn in the brain, and never absolute, but predispositions toward certain kinds of meaning-making and away from others...." (p. 844)
"But no matter whether it is the analyst or the analysand who resolves the dissociation first, the story does not end here. Understanding is more mysterious than the mere absence of dissociation; it does not necessarily fall into place as soon as our unconscious reasons to avoid it vanish. The view that comes to us from Heidegger, Gadamer, Merleau-Ponty, and others is that there is no way to codify the process by which understanding is reached. No one can say exactly why understanding comes about when it does, why horizons fuse now and not five minutes ago or yesterday, why language becomes able in one moment to contain experience that the moment before it could not. Even after dissociation has been resolved, the most we can do is allow history, or tradition, or the speech and conduct of the other, to act freely within us. We cannot decide to understand, even under the best of circumstances; we can only strive to put ourselves in the best position for understanding to occur. And so, while the resolution of the analyst's dissociation is crucial, it guarantees nothing: it merely means that the circular movement that may result in the expansion and flowering of meaning can occur with less obstruction by unconsciously held motivation. New understanding may follow immediately—or it may not. Resolving dissociations gives language its head, but what language will do then is beyond our capacity to know." (p. 871)
Donnel B. Stern (2003). The Fusion of Horizons: Dissociation, Enactment, and Understanding. Psychoanalytic Dialogues, Vol. 13, pp. 843-873
"But no matter whether it is the analyst or the analysand who resolves the dissociation first, the story does not end here. Understanding is more mysterious than the mere absence of dissociation; it does not necessarily fall into place as soon as our unconscious reasons to avoid it vanish. The view that comes to us from Heidegger, Gadamer, Merleau-Ponty, and others is that there is no way to codify the process by which understanding is reached. No one can say exactly why understanding comes about when it does, why horizons fuse now and not five minutes ago or yesterday, why language becomes able in one moment to contain experience that the moment before it could not. Even after dissociation has been resolved, the most we can do is allow history, or tradition, or the speech and conduct of the other, to act freely within us. We cannot decide to understand, even under the best of circumstances; we can only strive to put ourselves in the best position for understanding to occur. And so, while the resolution of the analyst's dissociation is crucial, it guarantees nothing: it merely means that the circular movement that may result in the expansion and flowering of meaning can occur with less obstruction by unconsciously held motivation. New understanding may follow immediately—or it may not. Resolving dissociations gives language its head, but what language will do then is beyond our capacity to know." (p. 871)
Donnel B. Stern (2003). The Fusion of Horizons: Dissociation, Enactment, and Understanding. Psychoanalytic Dialogues, Vol. 13, pp. 843-873
September 16, 2012
The Psychoanalytic Muse Reaches 10,000 Views
The Psychoanalytic Muse came into being on March 10, 2010. This weekend, in just 2.5 years, it reached a cumulative total of 10,000 views from 90 countries around the world. Such a tremendous response underscores the vibrancy that the ideas and practices developed by Freud, Jung, Adler, Ferenczi, Klein, Winnicott, Fordham, Hillman, Fairbairn, Kohut and others continue to have in our contemporary situation. Out of 146 posts, the most frequently read posting, by a margin of two to one, is the passage from Glen Gabbard and Thomas Ogden's On Becoming a Psychoanalyst. Freud's Remembering, Repeating and Working Through followed closely by Philip Bromberg's A Relational View of Resistence were the next two most frequently read postings. The most frequently accessed post by a Jungian author was the one titled Don Kalsched on the Defenses of Trauma. Thank you for your continued interest in analytic literature and this blog.
September 13, 2012
Ferro and Basile - Types of Countertransference Experience in the Analytic Field
"The field concept, originally formulated by Willy and Madeleine Baranger (Baranger & Baranger, 1961-62) has gradually assumed increasing complexity (M. Baranger, 1992; Eizirik 2005; Ferro 1996, 2002a, b;). Initially regarded as a situation whereby the products of the patient-analyst encounter are seen in terms of crossed resistances, and hence of the formation of bulwarks that are subsequently broken down by interpretations resulting from the analyst's ‘second-look’ capability, the field has increasingly become the locus of the multiple potentialities of analyst and patient alike and of all the possible worlds that may be opened up by their encounter. As we see it, it is not only a spatial but also a temporal field, inhabited by the present and the history, which constantly affords vistas onto the future. It is a field in a state of perennial transformation, a characteristic of which nothing can ever remain outside it after the ‘big bang’ of the possible worlds generated by the patient-analyst encounter within the setting. Places in the field are the present analyst-patient relationship, as well as their histories, transferences, and so on.
The field has a breath of its own, whose inhalation phase signals the arrival (or unfreezing) within it of lumps of unthinkability, while its exhalation is the collapse that follows every saturated interpretation, which reduces it to a point so as to prepare it for future expansion. This is of course an incessant movement. Another feature of the field is that sooner or later it must, however slightly, be infected by the patient's illness, and indeed itself contract that illness, in order to become the locus of the treatment and hence of transformations.
Thus, the field has an oscillatory character, swinging between the constant opening up of meaning (negative capability) on the one hand, and the unavoidable closure of meaning when it forgoes all possible stories in favour of the one pressing most strongly to be told (the selected fact).....
This suggests to me that, on the basis of a Bion-inspired view of the field enriched with concepts extrapolated from narratology, a whole series of progressively higher countertransference levels can be distinguished:
Countertransference level 0: When the field itself becomes the narrator and metabolizer of what happens in it, it digests, transforms and alphabetizes the primitive emotions aroused in it, and the signals of its functioning are picked up by the analyst, who is thus enabled to modulate them continuously. This is merely an ideal situation, because caesuras of various kinds will inevitably mobilize the events of the field. The characters of the session themselves assume the task of describing what is happening, thus allowing the analyst's interpretations to modulate the movements of the field. The analyst presides over a process co-generated by himself.
Countertransference level 1: The field is no longer able to absorb and modulate its own tensions, which instead impinge on the particular locus of the field that is the analyst's mind, thereby arousing in him an active, conscious reverie which he perceives and uses.
Countertransference level 2: When the field's tensions are so high that they overflow its central part, they overwhelm the analyst's capacity for reverie and activate particular experiences on his part, on which he must work inside himself in order, on the one hand, to digest and metabolize them and, on the other, to use them for understanding the patient and where appropriate for giving interpretations.
Countertransference level 3: The overflowing is so severe that the analyst as it were takes the problem home with him at night. Something remains encysted and needs to be worked through, for example by the precious tool of countertransference dreams.
Countertransference level 4: The overflowing is so bad that the analyst's very analytic function is overwhelmed, resulting in breaches of the setting ranging from a physical illness in the analyst to unrecognized enactments or dramatic manifestations that preclude continuation of the analysis. A field of this kind is imbued with the violations of the setting so well described by Gabbard & Lester (1995), in which it has not been possible to dissolve the countertransference and to manage it on the level of thought, so that it becomes a ‘thing’ or ‘fact’. At this point, given that one of the components of analysis — the setting — is lacking, what takes place can simply no longer be called analysis." (pp. 4-5)
Antonio Ferro and Roberto Basile (2008). Countertransference and the characters of the psychoanalytic session. Scandinavian Psychoanalytic Review, Vol. 31, pp. 3-10
The field has a breath of its own, whose inhalation phase signals the arrival (or unfreezing) within it of lumps of unthinkability, while its exhalation is the collapse that follows every saturated interpretation, which reduces it to a point so as to prepare it for future expansion. This is of course an incessant movement. Another feature of the field is that sooner or later it must, however slightly, be infected by the patient's illness, and indeed itself contract that illness, in order to become the locus of the treatment and hence of transformations.
Thus, the field has an oscillatory character, swinging between the constant opening up of meaning (negative capability) on the one hand, and the unavoidable closure of meaning when it forgoes all possible stories in favour of the one pressing most strongly to be told (the selected fact).....
This suggests to me that, on the basis of a Bion-inspired view of the field enriched with concepts extrapolated from narratology, a whole series of progressively higher countertransference levels can be distinguished:
Countertransference level 0: When the field itself becomes the narrator and metabolizer of what happens in it, it digests, transforms and alphabetizes the primitive emotions aroused in it, and the signals of its functioning are picked up by the analyst, who is thus enabled to modulate them continuously. This is merely an ideal situation, because caesuras of various kinds will inevitably mobilize the events of the field. The characters of the session themselves assume the task of describing what is happening, thus allowing the analyst's interpretations to modulate the movements of the field. The analyst presides over a process co-generated by himself.
Countertransference level 1: The field is no longer able to absorb and modulate its own tensions, which instead impinge on the particular locus of the field that is the analyst's mind, thereby arousing in him an active, conscious reverie which he perceives and uses.
Countertransference level 2: When the field's tensions are so high that they overflow its central part, they overwhelm the analyst's capacity for reverie and activate particular experiences on his part, on which he must work inside himself in order, on the one hand, to digest and metabolize them and, on the other, to use them for understanding the patient and where appropriate for giving interpretations.
Countertransference level 3: The overflowing is so severe that the analyst as it were takes the problem home with him at night. Something remains encysted and needs to be worked through, for example by the precious tool of countertransference dreams.
Countertransference level 4: The overflowing is so bad that the analyst's very analytic function is overwhelmed, resulting in breaches of the setting ranging from a physical illness in the analyst to unrecognized enactments or dramatic manifestations that preclude continuation of the analysis. A field of this kind is imbued with the violations of the setting so well described by Gabbard & Lester (1995), in which it has not been possible to dissolve the countertransference and to manage it on the level of thought, so that it becomes a ‘thing’ or ‘fact’. At this point, given that one of the components of analysis — the setting — is lacking, what takes place can simply no longer be called analysis." (pp. 4-5)
Antonio Ferro and Roberto Basile (2008). Countertransference and the characters of the psychoanalytic session. Scandinavian Psychoanalytic Review, Vol. 31, pp. 3-10
September 6, 2012
Elizabeth Urban: Jungian and Kleinian Notions of the Inner World
"A major, if not the major, difference between Freud and Jung lay in their views about the inner world. Freud's main emphasis was on the way contents of the mind are derived from personal experience, whereas Jung's studies viewed the mind as innately endowed with a priori configurations that encompass far more than personal contents. Klein too departed from Freud on this point, and the Controversial Discussions of the British Psycho-Analytical Society revolved around this issue (Hinshelwood 1989). Both Jung and Klein thought that the primary contents of the mind are inextricably bound up with the instincts, that, in fact, they are the mental representations of instincts.
According to Jung, the primary content of the psyche is the archetype. In contrast to instincts, the archetypes are ‘inborn forms of "intuition" ‘(Jung 1919, p. 133), analogous to instinct, with the difference that whereas instinct is a purposive impulse to carry out some highly complicated action, intuition is the unconscious, purposive apprehension of a highly complicated situation. (ibid. p. 132)
Jung also notes the similarities between archetypes and instincts. The archetypes make up the collective unconscious, which is universal and impersonal; that is, it is the same for all individuals. Instincts, according to Jung, are also impersonal and universal, and are, also like the archetypes, hereditary factors of a dynamic or motivating character. Thus, instincts ‘form very close analogues to the archetypes, so close, in fact, that there is good reason for supposing that the archetypes are the unconscious images of the instincts themselves’ (Jung 1936, pp. 43-4). Elsewhere he writes that the archetype ‘might suitably be described as the instinct's perception of itself, or as the self-portrait of the instinct’ (Jung 1919, p. 136).
Archetypes described in this way are virtually the same as Klein's unconscious phantasies. She writes, ‘I believe that phantasies operate from the outset, as do the instincts, and are the mental expression of the activity of both the life and death instincts’ (Klein 1952, p. 58). Isaacs presents a fuller exposition of the relationship between phantasies and instincts than does Klein. Isaacs states that ‘phantasies are the primary content of unconscious mental processes’ (Isaacs 1952, p. 82). ‘This "mental expression" of instinct is unconscious phantasy. Phantasy is (in the first instance) the mental corollary, the psychic representative, of instinct’ (ibid., p. 83).
Although for the most part Klein and Isaacs describe phantasies in terms of ‘stories’, for example, ‘I want to eat her all up’, these stories are based upon images: 'What, then, does the infant hallucinate? We may assume, since it is the oral impulse which is at work, first, the nipple, then the breast, and later his mother as a whole person; and he hallucinates the nipple or the breast in order to enjoy it. As we can see from his behaviour (sucking movements, sucking his own lip or a little later his fingers, and so on), hallucination does not stop at the mere picture, but carries him on to what he is, in detail, going to do with the desired object which he imagines (phantasies) he has obtained.' (ibid., p. 86)
The ‘picture’ of the breast that is an image of the instinct makes Isaacs's description of unconscious phantasies virtually identical to Jung's description of the archetype as the ‘self-portrait of the instinct’. When she writes ‘such knowledge [of the breast] is inherent … in the aim of instinct’ (ibid., p. 94), she can be understood to be talking about the same thing that Jung is describing when he states that the yucca moth has an image of the yucca flower and its structure, so that, when present externally, the flower sets off instinctual behaviour (Jung 1919). Both Jung and Isaacs are stating that there is an image of the aim of the instinct—the object that fulfils the instinctual urge—that exists within the psyche, enabling the instinct ‘to know what it is looking for’.
Important differences do, however, exist between Jung and Klein. Klein was a psychoanalyst who extended Freud's concepts of libidinal and destructive instincts to pre-Oedipal development, focusing on how infancy lies at the core of the personality. On the other hand, although Jung drew attention to the inherent richness of the mind before Klein began writing, his interest in childhood and infancy is limited. Although he refers to the individuality of the infant (Jung 1911, 1921), for the most part he thinks that the infant is in primary identity with the mother (Jung 1927). The issue of primary identity raises a number of questions which have since been addressed by Fordham." (pp. 412-413)
Elizabeth Urban (1992). The Primary Self and Related Concepts in Jung, Klein, and Isaacs. Journal of Analytical Psychology, Vol. 37, pp. 411-432
According to Jung, the primary content of the psyche is the archetype. In contrast to instincts, the archetypes are ‘inborn forms of "intuition" ‘(Jung 1919, p. 133), analogous to instinct, with the difference that whereas instinct is a purposive impulse to carry out some highly complicated action, intuition is the unconscious, purposive apprehension of a highly complicated situation. (ibid. p. 132)
Jung also notes the similarities between archetypes and instincts. The archetypes make up the collective unconscious, which is universal and impersonal; that is, it is the same for all individuals. Instincts, according to Jung, are also impersonal and universal, and are, also like the archetypes, hereditary factors of a dynamic or motivating character. Thus, instincts ‘form very close analogues to the archetypes, so close, in fact, that there is good reason for supposing that the archetypes are the unconscious images of the instincts themselves’ (Jung 1936, pp. 43-4). Elsewhere he writes that the archetype ‘might suitably be described as the instinct's perception of itself, or as the self-portrait of the instinct’ (Jung 1919, p. 136).
Archetypes described in this way are virtually the same as Klein's unconscious phantasies. She writes, ‘I believe that phantasies operate from the outset, as do the instincts, and are the mental expression of the activity of both the life and death instincts’ (Klein 1952, p. 58). Isaacs presents a fuller exposition of the relationship between phantasies and instincts than does Klein. Isaacs states that ‘phantasies are the primary content of unconscious mental processes’ (Isaacs 1952, p. 82). ‘This "mental expression" of instinct is unconscious phantasy. Phantasy is (in the first instance) the mental corollary, the psychic representative, of instinct’ (ibid., p. 83).
Although for the most part Klein and Isaacs describe phantasies in terms of ‘stories’, for example, ‘I want to eat her all up’, these stories are based upon images: 'What, then, does the infant hallucinate? We may assume, since it is the oral impulse which is at work, first, the nipple, then the breast, and later his mother as a whole person; and he hallucinates the nipple or the breast in order to enjoy it. As we can see from his behaviour (sucking movements, sucking his own lip or a little later his fingers, and so on), hallucination does not stop at the mere picture, but carries him on to what he is, in detail, going to do with the desired object which he imagines (phantasies) he has obtained.' (ibid., p. 86)
The ‘picture’ of the breast that is an image of the instinct makes Isaacs's description of unconscious phantasies virtually identical to Jung's description of the archetype as the ‘self-portrait of the instinct’. When she writes ‘such knowledge [of the breast] is inherent … in the aim of instinct’ (ibid., p. 94), she can be understood to be talking about the same thing that Jung is describing when he states that the yucca moth has an image of the yucca flower and its structure, so that, when present externally, the flower sets off instinctual behaviour (Jung 1919). Both Jung and Isaacs are stating that there is an image of the aim of the instinct—the object that fulfils the instinctual urge—that exists within the psyche, enabling the instinct ‘to know what it is looking for’.
Important differences do, however, exist between Jung and Klein. Klein was a psychoanalyst who extended Freud's concepts of libidinal and destructive instincts to pre-Oedipal development, focusing on how infancy lies at the core of the personality. On the other hand, although Jung drew attention to the inherent richness of the mind before Klein began writing, his interest in childhood and infancy is limited. Although he refers to the individuality of the infant (Jung 1911, 1921), for the most part he thinks that the infant is in primary identity with the mother (Jung 1927). The issue of primary identity raises a number of questions which have since been addressed by Fordham." (pp. 412-413)
Elizabeth Urban (1992). The Primary Self and Related Concepts in Jung, Klein, and Isaacs. Journal of Analytical Psychology, Vol. 37, pp. 411-432
September 2, 2012
Sandor Ferenczi's Impact on the Practice of Modern Short-Term Therapy
"Ferenczi's work was far ahead of its time. Certain techniques constituting the therapist's heightened activity level are now established as brief therapy principles and are evident throughout all phases of treatment, from assessment to termination. Davanloo (1978, 1980) and Sifneos (1987), in particular, focus their activity on the persistent challenging of defenses and on anxiety-provoking conflicts respectively. Their models require highly confrontational techniques aimed at stimulating emotions. Together with Malan (1963, 1976, 1979), these authors maintain an active transference approach and seek to bring together the affective and cognitive elements of treatment. The interactive process between patient and analyst is reciprocal and emotionally charged. Mann (1973) adheres to the active analytic position, but he also revives Ferenczi and Rank's concept of enforced termination. He believes that the setting of limits forces a patient to face reality and to give up unrealistic transference expectations.
As practiced by these major proponents of modem short-term therapy, the active transference approach involves increased verbal interaction between the patient and therapist. As Bauer and Kobos (1987) observe, a verbally active therapist is not compatible with a free-associating patient. In psychoanalysis, the therapist maintains a stance of evenly hovering attention and there are few interruptions into the patient's associations. In short-term therapy, the patient's associations are often directed by the therapist to explore specific material relevant to the focus and goals of treatment. For example, if a patient became more defensive when discussing a certain topic, Davanloo would forcefully challenge the patient's resistance. His approach often raises strong affect in the patient, particularly anger. By contrast, a practitioner of long-term psychoanalytic psychotherapy or psychoanalysis would tend to observe the pattern and development of resistance before confronting the patient.
Short-term therapists adhere to a focus on the core conflict and do not permit the patient to digress defensively from this central concern. As a result, the therapist is often confronting, clarifying, and interpreting defenses, thereby increasing the emotional intensity of the session. Since the treatment focus tends to involve issues which are expressed and explored in the therapeutic dyad, the level of emotional involvement is high for the therapist as well.
With the prevailing trend from one-person to two-person psychology, practitioners of short-term therapy generally acknowledge the interpersonal nature of therapy. The therapist is not viewed as a "blank screen" but rather as a coparticipant whose behavior shapes the transference. This approach is consistent with Ferenczi's insights on countertransference as a way to understand the patient's experience. Countertransference themes in short-term treatment often involve guilt and problems tolerating separation and loss. Shafer (1986) notes that brief treatment thwarts the therapists' re-parative need to completely heal the patient, as well as the need to be omniscient and omnipotent. Unlike long-term therapy, Mann (1986) observes that in short-term psychotherapy, therapists do not receive narcissistic gratification in having patients depend on them.
Brief Focal Psychotherapy, established by Malan, emphasizes another aspect of Ferenczi's work, namely concentrating the therapist's effort on analyzing the point at which trauma occurred. Malan, like Ferenczi, did not feel it was necessary to analyze every feature of the patient's mental life. Dealing with selective aspects of the patient's conflict is described in the other models as well. In his practice of Time-Limited Psychotherapy, for instance, Mann focuses on the central issue of the patient's chronically endured pain. Malan and Davanloo focus on the triangle of conflict (wish, anxiety, and defense) and the triangle of. insight (therapist, current relationship, and parent or past figure). Lastly, Sifneos' Short-Term Anxiety Provoking Psychotherapy concentrates on the patient's "circumscribed chief complaint."
The careful selection of patients is also common to the majority of short-term practice models. Given the high level of emotional intensity, patients must be able to benefit from this experience. It is therefore not surprising that these practitioners choose patients who are highly motivated, capable of insight, and able to establish a collaborative relationship with the therapist. These ego resources are necessary to help the patient throughout the arduous and painful treatment process.
Modem short-term therapy is characterized by a high level of commitment on the part of both the patient and therapist. This can also be seen in much of Ferenczi's work. Short-term therapists have had to continually defend their techniques as having been founded on core psychoanalytic principles. They have worked hard to dispel the myth that short-term therapy is superficial and dictated solely by factors extraneous to the patient's interest. Patients often turn to brief treatment as a last resort after other therapies have failed, as did Ferenczi's patients who came from all parts of the world with the hope of being cured.Conclusion
Sandor Ferenczi, a psychoanalytic pioneer and practitioner, suggested changes in psychoanalytic technique which would shorten the length of psychoanalysis. His introduction of "active therapy" involved increased activity from both the patient and analyst as a means to facilitate the exploration of unconscious material. The psychoanalyst prescribed the performance or cessation of certain behaviors, thus instituting active measures which made the patient a full participant in the psychoanalytic process. Interpretation, Ferenczi contended, was an active intervention which interrupted the patient's psychic activity, leading to the uncovering of repressed thoughts and ideas. In collaboration with Rank, Ferenczi underscored the importance of here-and-now transference interpretations and emphasized the emotional experiences of the patient in the transference, rather than the sole intellectual recovery of memories. Ferenczi noted that intellectual discovery without affect can serve as resistance.
Ferenczi's central ideas on active psychoanalytic treatment and interpretation are the cornerstone of modem dynamic short-term treatment. His ideas have been lauded and incorporated into the works of modern short-term therapists, such as Davanloo, Mann, and Sifneos. Ferenczi's emphasis on the importance of present life events in psychoanalytic treatment is currently receiving much attention in the psychotherapeutic community. This can be seen in the emphasis on the treatment of Axis I disorders and symptomatology, as well as the process of maintaining a process in most models of short-term treatment.
Sandor Ferenczi's incessant drive to improve psychoanalytic methodology has provided inspiration to modem short-term therapists. While Davanloo and others have had the benefit of years of development in research, theory, and technique, it was Ferenczi who pioneered these efforts and who served as a role model. His courage and experimental spirit embody the essence of psychoanalytic inquiry, and have, in my estimation, earned him the title of 'Forerunner of Modem Short-Term Psychotherapy'." (pp. 36-39)
Carol Tosone (1997). Sándor Ferenczi: Forerunner of Modern Short-Term Psychotherapy. Psychoanalytic Social Work, Vol. 4, pp. 23-41
As practiced by these major proponents of modem short-term therapy, the active transference approach involves increased verbal interaction between the patient and therapist. As Bauer and Kobos (1987) observe, a verbally active therapist is not compatible with a free-associating patient. In psychoanalysis, the therapist maintains a stance of evenly hovering attention and there are few interruptions into the patient's associations. In short-term therapy, the patient's associations are often directed by the therapist to explore specific material relevant to the focus and goals of treatment. For example, if a patient became more defensive when discussing a certain topic, Davanloo would forcefully challenge the patient's resistance. His approach often raises strong affect in the patient, particularly anger. By contrast, a practitioner of long-term psychoanalytic psychotherapy or psychoanalysis would tend to observe the pattern and development of resistance before confronting the patient.
Short-term therapists adhere to a focus on the core conflict and do not permit the patient to digress defensively from this central concern. As a result, the therapist is often confronting, clarifying, and interpreting defenses, thereby increasing the emotional intensity of the session. Since the treatment focus tends to involve issues which are expressed and explored in the therapeutic dyad, the level of emotional involvement is high for the therapist as well.
With the prevailing trend from one-person to two-person psychology, practitioners of short-term therapy generally acknowledge the interpersonal nature of therapy. The therapist is not viewed as a "blank screen" but rather as a coparticipant whose behavior shapes the transference. This approach is consistent with Ferenczi's insights on countertransference as a way to understand the patient's experience. Countertransference themes in short-term treatment often involve guilt and problems tolerating separation and loss. Shafer (1986) notes that brief treatment thwarts the therapists' re-parative need to completely heal the patient, as well as the need to be omniscient and omnipotent. Unlike long-term therapy, Mann (1986) observes that in short-term psychotherapy, therapists do not receive narcissistic gratification in having patients depend on them.
Brief Focal Psychotherapy, established by Malan, emphasizes another aspect of Ferenczi's work, namely concentrating the therapist's effort on analyzing the point at which trauma occurred. Malan, like Ferenczi, did not feel it was necessary to analyze every feature of the patient's mental life. Dealing with selective aspects of the patient's conflict is described in the other models as well. In his practice of Time-Limited Psychotherapy, for instance, Mann focuses on the central issue of the patient's chronically endured pain. Malan and Davanloo focus on the triangle of conflict (wish, anxiety, and defense) and the triangle of. insight (therapist, current relationship, and parent or past figure). Lastly, Sifneos' Short-Term Anxiety Provoking Psychotherapy concentrates on the patient's "circumscribed chief complaint."
The careful selection of patients is also common to the majority of short-term practice models. Given the high level of emotional intensity, patients must be able to benefit from this experience. It is therefore not surprising that these practitioners choose patients who are highly motivated, capable of insight, and able to establish a collaborative relationship with the therapist. These ego resources are necessary to help the patient throughout the arduous and painful treatment process.
Modem short-term therapy is characterized by a high level of commitment on the part of both the patient and therapist. This can also be seen in much of Ferenczi's work. Short-term therapists have had to continually defend their techniques as having been founded on core psychoanalytic principles. They have worked hard to dispel the myth that short-term therapy is superficial and dictated solely by factors extraneous to the patient's interest. Patients often turn to brief treatment as a last resort after other therapies have failed, as did Ferenczi's patients who came from all parts of the world with the hope of being cured.Conclusion
Sandor Ferenczi, a psychoanalytic pioneer and practitioner, suggested changes in psychoanalytic technique which would shorten the length of psychoanalysis. His introduction of "active therapy" involved increased activity from both the patient and analyst as a means to facilitate the exploration of unconscious material. The psychoanalyst prescribed the performance or cessation of certain behaviors, thus instituting active measures which made the patient a full participant in the psychoanalytic process. Interpretation, Ferenczi contended, was an active intervention which interrupted the patient's psychic activity, leading to the uncovering of repressed thoughts and ideas. In collaboration with Rank, Ferenczi underscored the importance of here-and-now transference interpretations and emphasized the emotional experiences of the patient in the transference, rather than the sole intellectual recovery of memories. Ferenczi noted that intellectual discovery without affect can serve as resistance.
Ferenczi's central ideas on active psychoanalytic treatment and interpretation are the cornerstone of modem dynamic short-term treatment. His ideas have been lauded and incorporated into the works of modern short-term therapists, such as Davanloo, Mann, and Sifneos. Ferenczi's emphasis on the importance of present life events in psychoanalytic treatment is currently receiving much attention in the psychotherapeutic community. This can be seen in the emphasis on the treatment of Axis I disorders and symptomatology, as well as the process of maintaining a process in most models of short-term treatment.
Sandor Ferenczi's incessant drive to improve psychoanalytic methodology has provided inspiration to modem short-term therapists. While Davanloo and others have had the benefit of years of development in research, theory, and technique, it was Ferenczi who pioneered these efforts and who served as a role model. His courage and experimental spirit embody the essence of psychoanalytic inquiry, and have, in my estimation, earned him the title of 'Forerunner of Modem Short-Term Psychotherapy'." (pp. 36-39)
Carol Tosone (1997). Sándor Ferenczi: Forerunner of Modern Short-Term Psychotherapy. Psychoanalytic Social Work, Vol. 4, pp. 23-41
August 20, 2012
Jean Knox - Attachment Theory and Contemporary Jungian Views
"In the introduction I pointed out Jung's interest in dissociation as opposed to Freud's focus on repression as the mechanism whereby material is kept out of consciousness. I will now turn to attachment theory again to discuss the concept of defensive exclusion and its relationship to the formation of internal working models.
I am aware that I have not yet satisfactorily dealt with the question of the discrepancy between events or people in the real world and the representations of those people or events, which often seem such distorted images of the real world. Drive theory accounts for this quite easily with its model of instinctual phantasy, out of which arise internal objects which do not reflect the external world.
However an alternative model can be derived from attachment theory. Separation anxiety is constantly activated in childhood, activating fears of abandonment and annihilation based on the growing child's sense of dependence and vulnerability. Separation, narcissistic and Oedipal anxieties are defended against by omnipotent and grandiose fantasy and experience is filtered through these defences, so that unbearable fears or events are excluded from conscious attention and awareness. However this does not prevent the fears and the defences from being inextricably bound up with the internalized image or memory of the event, so that the defences become part of the schematized patterns which are being formed in implicit memory as well as the events themselves.
The internal working model (or complex) therefore reflects these fears and defences and so may take a very different form from the person or event in the real world; the degree of distortion probably reflects the relative contribution of fear and defensive fantasy to the internal working model. This provides us with an alternative way of conceptualizing unconscious fantasy from that of instinctual drives.
Internal working models which reflect threatening past experience lead to further defensive exclusion of any encounter which activates the schema, so that there is a withdrawal or avoidance of engagement and relationship. This leads to an inability to learn from new experience and a failure to modify the internal working model, which remains encapsulated and split off from the rest of the psyche, just as Jung described complexes being dissociated ‘splinter psyches’.
Conclusion: Internal psychic reality is formed from the internalization of accumulated past experience of key attachment figures and is not an expression of innate instinctual drives. The concept of implicit memory provides us with an experimentally-based account of the way in which experiences are internalized and stored in a generalized schematic form which is not available to recall or conscious awareness, but which patterns our expectations of, and perception of, present attachments and relationships.
These schematized patterns are equated with the internal working models of attachment theory; the contribution of defensive exclusion to the formation of internal working models is discussed. I also suggest that internal working models have many features in common with the Jungian concept of complexes and a new view of complexes is therefore being proposed." (pp. 527-528)
Jean Knox (1999). The relevance of attachment theory to a contemporary Jungian view of the internal world. Journal of Analytical Psychology, Vol. 44, pp. 511-530
I am aware that I have not yet satisfactorily dealt with the question of the discrepancy between events or people in the real world and the representations of those people or events, which often seem such distorted images of the real world. Drive theory accounts for this quite easily with its model of instinctual phantasy, out of which arise internal objects which do not reflect the external world.
However an alternative model can be derived from attachment theory. Separation anxiety is constantly activated in childhood, activating fears of abandonment and annihilation based on the growing child's sense of dependence and vulnerability. Separation, narcissistic and Oedipal anxieties are defended against by omnipotent and grandiose fantasy and experience is filtered through these defences, so that unbearable fears or events are excluded from conscious attention and awareness. However this does not prevent the fears and the defences from being inextricably bound up with the internalized image or memory of the event, so that the defences become part of the schematized patterns which are being formed in implicit memory as well as the events themselves.
The internal working model (or complex) therefore reflects these fears and defences and so may take a very different form from the person or event in the real world; the degree of distortion probably reflects the relative contribution of fear and defensive fantasy to the internal working model. This provides us with an alternative way of conceptualizing unconscious fantasy from that of instinctual drives.
Internal working models which reflect threatening past experience lead to further defensive exclusion of any encounter which activates the schema, so that there is a withdrawal or avoidance of engagement and relationship. This leads to an inability to learn from new experience and a failure to modify the internal working model, which remains encapsulated and split off from the rest of the psyche, just as Jung described complexes being dissociated ‘splinter psyches’.
Conclusion: Internal psychic reality is formed from the internalization of accumulated past experience of key attachment figures and is not an expression of innate instinctual drives. The concept of implicit memory provides us with an experimentally-based account of the way in which experiences are internalized and stored in a generalized schematic form which is not available to recall or conscious awareness, but which patterns our expectations of, and perception of, present attachments and relationships.
These schematized patterns are equated with the internal working models of attachment theory; the contribution of defensive exclusion to the formation of internal working models is discussed. I also suggest that internal working models have many features in common with the Jungian concept of complexes and a new view of complexes is therefore being proposed." (pp. 527-528)
Jean Knox (1999). The relevance of attachment theory to a contemporary Jungian view of the internal world. Journal of Analytical Psychology, Vol. 44, pp. 511-530
August 7, 2012
Irene Ruggiero - The Unreachable Object?
"It is well known that various models exist to explain the genesis and the structure of the borderline disturbance. One model emphasizes the role of aggression and of envy: they are thought to be characterized by an individual, constitutionally determined threshold (the so-called ‘conflict model’ which dates back to Kernberg’s thought). The other model instead gives prominence to a lack of attunement in the primary environment, which is thought to hinder the formation of those internal structures of self-regulation without which it is not possible to reach a sufficient level of cohesion of the self and become autonomous from archaic relationships with the selfobjects (this is the so-called ‘deficit model’ which emerges from the theories of Kohut). These models have led to divergent views about the most important factors in the therapy. In the ‘conflict model’, stress is placed on the steadfastness of the analytic setting (the stability of which reassures the patient that the analyst can contain and survive his destructiveness), and on the instrument of interpretation (this method allows confronting the patient on the issue of his aggression early in the process). However, the deficit model emphasizes above all attention to the ego-attuned subjectivity of the patient, and endorses the provision of the physiological fusion which was missing in the primary relationship.
Several colleagues (including Casement, 1990; Correale and Berti Ceroni, 1997; Modell, 1988; Monari, 1999), who highlight the opportunity to use both approaches, the ‘empathic’ and the interpretative, seeing these as the development of a single original matrix, believe that a sort of treatment in two phases may be particularly useful. In the early phase, the functions of containment, empathic mirroring and support predominate, with the use of interpretation being held back for the second phase.
This position, in which I recognize myself, is also borne out of the consideration that – as is often the case with traumatized people – in borderline individuals, behaviours and fantasies characterized by a certain level of automatism are present, accompanied by a reduction in the capacity to represent and the overdevelopment of the emotional components. In these moments of sensorial over-excitement, interpretative activities carry a risk of overburdening the patient further, who is already caught up in difficulties of mentalization. Meanwhile the activities of presence and connection assume great importance (Correale, 2006).
I share the position of those (Mitchell, 1993) who maintain that aggression, whilst having its own innate individual potential, is activated in relational and environmental situations that are perceived subjectively as being dangerous, a point which explains the particular sensitivity of borderline patients to minimal variations in the therapeutic environment. If, as I think, traumatic factors play an essential role in the genesis and the emergence of borderline functioning, we need to give particular attention to the microtraumas which can come about in the consulting room and to anti-therapeutic factors which can be attributed to the analyst’s difficulties (Ferenczi, 1932), as well as those activated by the difficulties of the patient. The specific contribution of my work consists in exploring the nature and possibility of using the countertransference in the game of symmetry and asymmetry which is created between the unconscious of the patient and the analyst. This is a game which works, more specifically, when the transference does not only manifest itself through words.
With borderline patients, in whom extensive areas remain unavailable to representation, it is necessary to work at length to cement a narcissistic tissue which is rather frayed. Before being able to use interpretative instruments, it is often necessary to undertake a long piece of analytic work which facilitates the transformation of as yet non-representable elements into representations that can be thought, dreamed and expressed in words.
One of the most specific difficulties that the analyst must confront in this work is the intense amount of destructiveness that these patients bring and activate. Whether this is determined by constitution or whether it represents the outcome of deficient primary relationships, the containment of the – sometimes raging – aggression of the borderline patient constitutes an unavoidable technical knot and a hard test for the analyst. Personally, I share the belief that it is fundamental to provide these patients with the potential to test the analytic setting as trustworthy and authentically containing before interpreting their intense destructiveness, which is often not yet available to thought." (pp. 586-587)
Irene Ruggiero (2012) The Unreachable Object? Difficulties and Paradoxes in the Analytical Relationship with Borderline Patients, International Journal of Psychoanalysis, Vol. 93, pp. 585–606
Several colleagues (including Casement, 1990; Correale and Berti Ceroni, 1997; Modell, 1988; Monari, 1999), who highlight the opportunity to use both approaches, the ‘empathic’ and the interpretative, seeing these as the development of a single original matrix, believe that a sort of treatment in two phases may be particularly useful. In the early phase, the functions of containment, empathic mirroring and support predominate, with the use of interpretation being held back for the second phase.
This position, in which I recognize myself, is also borne out of the consideration that – as is often the case with traumatized people – in borderline individuals, behaviours and fantasies characterized by a certain level of automatism are present, accompanied by a reduction in the capacity to represent and the overdevelopment of the emotional components. In these moments of sensorial over-excitement, interpretative activities carry a risk of overburdening the patient further, who is already caught up in difficulties of mentalization. Meanwhile the activities of presence and connection assume great importance (Correale, 2006).
I share the position of those (Mitchell, 1993) who maintain that aggression, whilst having its own innate individual potential, is activated in relational and environmental situations that are perceived subjectively as being dangerous, a point which explains the particular sensitivity of borderline patients to minimal variations in the therapeutic environment. If, as I think, traumatic factors play an essential role in the genesis and the emergence of borderline functioning, we need to give particular attention to the microtraumas which can come about in the consulting room and to anti-therapeutic factors which can be attributed to the analyst’s difficulties (Ferenczi, 1932), as well as those activated by the difficulties of the patient. The specific contribution of my work consists in exploring the nature and possibility of using the countertransference in the game of symmetry and asymmetry which is created between the unconscious of the patient and the analyst. This is a game which works, more specifically, when the transference does not only manifest itself through words.
With borderline patients, in whom extensive areas remain unavailable to representation, it is necessary to work at length to cement a narcissistic tissue which is rather frayed. Before being able to use interpretative instruments, it is often necessary to undertake a long piece of analytic work which facilitates the transformation of as yet non-representable elements into representations that can be thought, dreamed and expressed in words.
One of the most specific difficulties that the analyst must confront in this work is the intense amount of destructiveness that these patients bring and activate. Whether this is determined by constitution or whether it represents the outcome of deficient primary relationships, the containment of the – sometimes raging – aggression of the borderline patient constitutes an unavoidable technical knot and a hard test for the analyst. Personally, I share the belief that it is fundamental to provide these patients with the potential to test the analytic setting as trustworthy and authentically containing before interpreting their intense destructiveness, which is often not yet available to thought." (pp. 586-587)
Irene Ruggiero (2012) The Unreachable Object? Difficulties and Paradoxes in the Analytical Relationship with Borderline Patients, International Journal of Psychoanalysis, Vol. 93, pp. 585–606
August 2, 2012
Hans Dieckmann - Fairytales in Analysis
"Such a favourite fairy-tale could be found in the unconscious of most of the patients I treated over a long period. Not all of them have been common fairy-tales. There were a lot of not so well-known ones from Andersen, Hauff, Brentano and others, and, also, though seldom, stories from modern children's books like Winnie-the-Pooh, Alice in Wonderland, etc. In most cases this material was more or less repressed in the unconscious.
If you ask the patient during the first session you usually get one of the common traditional fairy-tales remembered at that moment, such as Cinderella, Snow-White and the Seven Dwarfs, or Little Red Riding Hood, as the investigations of Wittgenstein (1955) have shown. The really individual favourite fairy-tale will emerge from the unconscious for the first time after some regression into the early childhood has taken place. Sometimes a dream symbol will give the first hint of it, sometimes the associations of the patient during a certain period of childhood. To my own astonishment this material was very individualistic. Among the 50 patients the same tales have been found only two or three times.
It is hardly surprising that one should find, at least in most European patients, a favourite fairy-tale from childhood. As a rule, such tales are among the earliest cultural products taken up by the human soul. In this way the typical imaginings of the culture can be assimilated and the structures of the archetype per se filled out with forms and pictures. On the other hand the main fairy-tale period of childhood is also the time when fundamental neurotic patterns are formed and the first neurotic symptoms come into existence. So we may have here a very important point: that the fairy-tale can tell us something about the basic structure and dynamics of the individual neurosis. It may also show us the organization of ideas and experiences of archetypal forms (Dieckmann, 1967). The partial or total identification of the ego with an archetypal image as the nuclear charge of a complex is one of the principal criteria of neurosis.
On the other hand the healthy ego-complex will only have such identifications in a passing way (Jacobi, 1942). So it is reasonable that we should also find such fixed identifications if the favourite fairy-tales of childhood return to consciousness during the course of analytical treatment. In practice one finds in this way many comparisons between the themes or symbols of the fairy-tale and the symptoms of neurosis." (pp. 22-23)
"It seems to me that a real understanding on the symbolic level of the solution of the problem in the fairy-tale is of great importance also for the analyst. All fairy-tales include individuation processes as is shown by many authors (v. Franz, v. Beit, Jaffé, Dieckmann, Laiblin and others) and they show in a symbolic form different ways of psychic growth and progress. So it may be possible to translate them in a behaviouristic way and to understand them on the objective level. This will lead to complications, because in this case the analyst will unconsciously accept the identification of the patient's ego with the image of the archetype." (p. 28)
"In a large number of patients favourite fairy-tales arise from the unconscious in connection with dreams, fantasies or associations. The main fairy-tale time of childhood is the time in which fundamental neurotic patterns are laid down and the first neurotic symptoms appear. There is a strong connection between these fairy-tales and the symptoms of the later neurosis, the structure of the personality and the patterns of behaviour. Such correlations have been investigated in 50 patients. Examples are presented in this paper.
Fairy-tales are among the earliest cultural products absorbed by the human soul. In this way the typical images of the culture can be assimilated and the structure of the archetype per se filled out with forms and pictures. Therefore the fairy-tale can be used as a diagnostic tool for the determination of the neurotic archetypal fixation.
The material shows the therapeutic value of bringing these images into consciousness and working them through at a symbolic level." (p. 29)
Hans Dieckmann (1971). The Favourite Fairy-Tale of Childhood. Journal of Analytical Psychology, Vol. 16, pp. 18-30
If you ask the patient during the first session you usually get one of the common traditional fairy-tales remembered at that moment, such as Cinderella, Snow-White and the Seven Dwarfs, or Little Red Riding Hood, as the investigations of Wittgenstein (1955) have shown. The really individual favourite fairy-tale will emerge from the unconscious for the first time after some regression into the early childhood has taken place. Sometimes a dream symbol will give the first hint of it, sometimes the associations of the patient during a certain period of childhood. To my own astonishment this material was very individualistic. Among the 50 patients the same tales have been found only two or three times.
It is hardly surprising that one should find, at least in most European patients, a favourite fairy-tale from childhood. As a rule, such tales are among the earliest cultural products taken up by the human soul. In this way the typical imaginings of the culture can be assimilated and the structures of the archetype per se filled out with forms and pictures. On the other hand the main fairy-tale period of childhood is also the time when fundamental neurotic patterns are formed and the first neurotic symptoms come into existence. So we may have here a very important point: that the fairy-tale can tell us something about the basic structure and dynamics of the individual neurosis. It may also show us the organization of ideas and experiences of archetypal forms (Dieckmann, 1967). The partial or total identification of the ego with an archetypal image as the nuclear charge of a complex is one of the principal criteria of neurosis.
On the other hand the healthy ego-complex will only have such identifications in a passing way (Jacobi, 1942). So it is reasonable that we should also find such fixed identifications if the favourite fairy-tales of childhood return to consciousness during the course of analytical treatment. In practice one finds in this way many comparisons between the themes or symbols of the fairy-tale and the symptoms of neurosis." (pp. 22-23)
"It seems to me that a real understanding on the symbolic level of the solution of the problem in the fairy-tale is of great importance also for the analyst. All fairy-tales include individuation processes as is shown by many authors (v. Franz, v. Beit, Jaffé, Dieckmann, Laiblin and others) and they show in a symbolic form different ways of psychic growth and progress. So it may be possible to translate them in a behaviouristic way and to understand them on the objective level. This will lead to complications, because in this case the analyst will unconsciously accept the identification of the patient's ego with the image of the archetype." (p. 28)
"In a large number of patients favourite fairy-tales arise from the unconscious in connection with dreams, fantasies or associations. The main fairy-tale time of childhood is the time in which fundamental neurotic patterns are laid down and the first neurotic symptoms appear. There is a strong connection between these fairy-tales and the symptoms of the later neurosis, the structure of the personality and the patterns of behaviour. Such correlations have been investigated in 50 patients. Examples are presented in this paper.
Fairy-tales are among the earliest cultural products absorbed by the human soul. In this way the typical images of the culture can be assimilated and the structure of the archetype per se filled out with forms and pictures. Therefore the fairy-tale can be used as a diagnostic tool for the determination of the neurotic archetypal fixation.
The material shows the therapeutic value of bringing these images into consciousness and working them through at a symbolic level." (p. 29)
Hans Dieckmann (1971). The Favourite Fairy-Tale of Childhood. Journal of Analytical Psychology, Vol. 16, pp. 18-30
July 29, 2012
Juan Tubert-Oklander - The Nature of the Alpha Function
"So what is the alpha function, after all? Bion did not say it; indeed, he was adamant in his opposition to any premature saturation of the term. I do not claim to have found the "real" meaning of the term, but only a possible one, to be derived from the resonance between psychoanalysis, semiotics, and a theory of development. Of course, if the concept were to resonate with other different points of view, it would be imbued with new meanings.
From this vertex, the alpha function appears as an organizing activity, more specifically, as a classificatory endeavour. The baby's experience is initially an aggregate of disparate elements, which include sensory and organic impressions, as well as those obscure inner motions that adumbrate what later will become the emotions. It is a motley assembly of contrasting items, which cannot be assigned any definite meaning. This is a situation similar to the state of chemical knowledge before Mendeleyev. At that time, a chemist had to memorize the characteristics of every one of the elements, which showed no relation whatsoever among them. It was just a lot of fruitless and dull work. Then came Dmitry Ivanovich Mendeleyev, with his love of pattern, and tried to sort them out. He assumed, as an act of faith, that there had to be an order in Nature, and set out to find it in the chemical realm. He ordered the elements sequentially, by their atomic weight, and soon found out that some features seemed to reappear every eight elements; it was something akin to an octave in music. So he placed the elements in tiers, with eight of them in each one, and found that all the elements in each vertical column had a veritable family resemblance. His belief in this rhythmic distribution was so strong that, when some element seemed to be out of place, he asserted that its atomic weigh must have been wrongly calculated, and he was right! He also went as far as to predict that some element yet undiscovered must exist, whenever he was faced with an empty cell in his table, and he was right again. This, of course, resembles the case of another scientist who shared the Russian chemist's belief in pattern and rhythm: Wilfred Ruprecht Bion and his Grid.
Now, the baby, immersed in a state of confusion and ambiguity, is looking for its Mendeleyev, and finds him in its own mother. Her capacity to be in touch with the emotional experiences that her baby induces in her, to think them through in a sensible and meaningful way, and to act accordingly in order to respond to her offspring's needs, puts the latter's world into order, thus initiating the development of an inner "grid," which is the very foundation of thought.
But there is one important difference between this metaphor and the actual process that seems to take place between the baby and its mother. The classificatory activity carried out by Mendeleyev might have been done on a blackboard, a notebook, or on a table, by distributing cards in heaps; in other words, any classification needs a space or surface on which to distribute the items that are being classified. But in the case of the baby, the classificatory space does not exist before the classificatory effort, but is rather created by that very effort. Thus this putting of the baby's experience into order is the beginning of that inner space that is indispensable for thinking, feeling, imagining, dreaming, or acting in a meaningful way (Tubert-Oklander, 1987).
But the story of Mendeleyev and his Table of the Elements may well be something more than a suitable metaphor. Bion warned us against restricting the use of the concept of the alpha function to a single field of inquiry, so that it will not do to conceive it just as a part of a genetic theory of early development, even though it may well be profitably used in that field. The case of Mendeleyev shows that the alpha function may also be used as a hypothesis for understanding the development of science or knowledge in general—i.e., in epistemological research. From such point of view, Mendeleyev's prowess may be conceived as an instance of the alpha function, and not as its analogue.
This is related to a new term I have introduced in the discussion, that of the act of faith. This is another of Bion's concepts, which is rather ambiguous and unsettling, just as is most of his work. In was introduced in his book Attention and Interpretation, in the following terms:
The discipline that I propose for the analyst, namely avoidance of memory and desire … increases his ability to exercise "acts of faith." An "act of faith" is peculiar to scientific procedure and must be distinguished from the religious meaning with which it is invested in conventional usage; it becomes apprehensible when it can be represented in and by thought. It must "evolve" before it can be apprehended and it is apprehended when it is a thought just as the artist's O is apprehensible when it has been transformed into a work of art. (Bion, 1970, pp. )
So the act of faith seems to be a primary intuition, which underlies all scientific thinking and research: the intuition that the world has an order that we are somehow capable of fathoming, in other words, the intuition that truth exists (Tubert-Oklander, 2008b). It was only the intuition that there was some meaning there to be found that kept Mendeleyev working to make sense out of haphazard chemical knowledge, Champollion out of the undecipherable hieroglyphics on the Rosetta stone, and Freud out of the mumbo-jumbo of dreams. It is the very same faith that drives the mother to find a meaning—and, perhaps, also construct a meaning—for her baby's seemingly unrelated expressions. And this capacity for faith may also, perhaps, be the outcome of a good and fruitful experience of being contained, understood, nourished, and loved by a caring mother— an aspect of what Erik Erikson (1987) called "basic trust."
If this were the case, Bion's work and thought might be relevant for a much wider field of knowledge than the theory and practice of psychoanalysis, since it provides the rudiments of a general theory of thought and knowledge, integrated with emotional experience and personal relations. Just as semiotics has evolved from mere linguistics into a wide discipline that studies such apparently dissimilar phenomena as sign language, dressing codes, manners, family and social organization, architectural codes, advertising, the structure of short stories and other narratives, the meaning of objects in everyday life, and heraldry, Bion's theory of thinking may well be carried much further than the ordinary limits of psychoanalysis, into the realms of anthropology, social psychology, political science, episte-mology, and also, of course, semiotics. In the meantime, the concept of the alpha function remains—and most probably shall remain—as unsaturated as Bion bequeathed it to us. From this perspective, my inquiry of the alpha function is no more that that: playing with a conceptual object, to see how it functions and what meanings it generates, when placed and used in a particular context. This awaits for further inquiries in other relevant contexts. But this is the very stuff of interpretation, in a hermeneutical sense: to place a given text in various contexts and determine, from the meanings thus generated, which of these contexts seems to fit better with the fruitfulness of the text (Beuchot, 2005; Tubert-Oklander & Beuchot Puente, 2008)." (pp. 240-241)
Juan Tubert-Oklander (2008). An Inquiry into the Alpha Function. Canadian Journal of Psychoanalysis, Vol. 16, pp. 224-245
From this vertex, the alpha function appears as an organizing activity, more specifically, as a classificatory endeavour. The baby's experience is initially an aggregate of disparate elements, which include sensory and organic impressions, as well as those obscure inner motions that adumbrate what later will become the emotions. It is a motley assembly of contrasting items, which cannot be assigned any definite meaning. This is a situation similar to the state of chemical knowledge before Mendeleyev. At that time, a chemist had to memorize the characteristics of every one of the elements, which showed no relation whatsoever among them. It was just a lot of fruitless and dull work. Then came Dmitry Ivanovich Mendeleyev, with his love of pattern, and tried to sort them out. He assumed, as an act of faith, that there had to be an order in Nature, and set out to find it in the chemical realm. He ordered the elements sequentially, by their atomic weight, and soon found out that some features seemed to reappear every eight elements; it was something akin to an octave in music. So he placed the elements in tiers, with eight of them in each one, and found that all the elements in each vertical column had a veritable family resemblance. His belief in this rhythmic distribution was so strong that, when some element seemed to be out of place, he asserted that its atomic weigh must have been wrongly calculated, and he was right! He also went as far as to predict that some element yet undiscovered must exist, whenever he was faced with an empty cell in his table, and he was right again. This, of course, resembles the case of another scientist who shared the Russian chemist's belief in pattern and rhythm: Wilfred Ruprecht Bion and his Grid.
Now, the baby, immersed in a state of confusion and ambiguity, is looking for its Mendeleyev, and finds him in its own mother. Her capacity to be in touch with the emotional experiences that her baby induces in her, to think them through in a sensible and meaningful way, and to act accordingly in order to respond to her offspring's needs, puts the latter's world into order, thus initiating the development of an inner "grid," which is the very foundation of thought.
But there is one important difference between this metaphor and the actual process that seems to take place between the baby and its mother. The classificatory activity carried out by Mendeleyev might have been done on a blackboard, a notebook, or on a table, by distributing cards in heaps; in other words, any classification needs a space or surface on which to distribute the items that are being classified. But in the case of the baby, the classificatory space does not exist before the classificatory effort, but is rather created by that very effort. Thus this putting of the baby's experience into order is the beginning of that inner space that is indispensable for thinking, feeling, imagining, dreaming, or acting in a meaningful way (Tubert-Oklander, 1987).
But the story of Mendeleyev and his Table of the Elements may well be something more than a suitable metaphor. Bion warned us against restricting the use of the concept of the alpha function to a single field of inquiry, so that it will not do to conceive it just as a part of a genetic theory of early development, even though it may well be profitably used in that field. The case of Mendeleyev shows that the alpha function may also be used as a hypothesis for understanding the development of science or knowledge in general—i.e., in epistemological research. From such point of view, Mendeleyev's prowess may be conceived as an instance of the alpha function, and not as its analogue.
This is related to a new term I have introduced in the discussion, that of the act of faith. This is another of Bion's concepts, which is rather ambiguous and unsettling, just as is most of his work. In was introduced in his book Attention and Interpretation, in the following terms:
The discipline that I propose for the analyst, namely avoidance of memory and desire … increases his ability to exercise "acts of faith." An "act of faith" is peculiar to scientific procedure and must be distinguished from the religious meaning with which it is invested in conventional usage; it becomes apprehensible when it can be represented in and by thought. It must "evolve" before it can be apprehended and it is apprehended when it is a thought just as the artist's O is apprehensible when it has been transformed into a work of art. (Bion, 1970, pp. )
So the act of faith seems to be a primary intuition, which underlies all scientific thinking and research: the intuition that the world has an order that we are somehow capable of fathoming, in other words, the intuition that truth exists (Tubert-Oklander, 2008b). It was only the intuition that there was some meaning there to be found that kept Mendeleyev working to make sense out of haphazard chemical knowledge, Champollion out of the undecipherable hieroglyphics on the Rosetta stone, and Freud out of the mumbo-jumbo of dreams. It is the very same faith that drives the mother to find a meaning—and, perhaps, also construct a meaning—for her baby's seemingly unrelated expressions. And this capacity for faith may also, perhaps, be the outcome of a good and fruitful experience of being contained, understood, nourished, and loved by a caring mother— an aspect of what Erik Erikson (1987) called "basic trust."
If this were the case, Bion's work and thought might be relevant for a much wider field of knowledge than the theory and practice of psychoanalysis, since it provides the rudiments of a general theory of thought and knowledge, integrated with emotional experience and personal relations. Just as semiotics has evolved from mere linguistics into a wide discipline that studies such apparently dissimilar phenomena as sign language, dressing codes, manners, family and social organization, architectural codes, advertising, the structure of short stories and other narratives, the meaning of objects in everyday life, and heraldry, Bion's theory of thinking may well be carried much further than the ordinary limits of psychoanalysis, into the realms of anthropology, social psychology, political science, episte-mology, and also, of course, semiotics. In the meantime, the concept of the alpha function remains—and most probably shall remain—as unsaturated as Bion bequeathed it to us. From this perspective, my inquiry of the alpha function is no more that that: playing with a conceptual object, to see how it functions and what meanings it generates, when placed and used in a particular context. This awaits for further inquiries in other relevant contexts. But this is the very stuff of interpretation, in a hermeneutical sense: to place a given text in various contexts and determine, from the meanings thus generated, which of these contexts seems to fit better with the fruitfulness of the text (Beuchot, 2005; Tubert-Oklander & Beuchot Puente, 2008)." (pp. 240-241)
Juan Tubert-Oklander (2008). An Inquiry into the Alpha Function. Canadian Journal of Psychoanalysis, Vol. 16, pp. 224-245
July 24, 2012
Margaret Wilkinson - Transference, Neuroscience, and Integration
"Perhaps as yet speculative, nevertheless it may be inferred that the analytic process, and the evolving symbolizations associated with it, can develop new neural pathways in the brain, and in particular can develop the fibre tract known as the corpus callosum that is the major highway between the two hemispheres, shown to be reduced through the effects of trauma (Teicher 2000). Such integration is facilitated as, through the experience of the transference, past is linked with present and emotional experience revisited and reworked. Through the analytic process, new entities are added to pre-existing connections, in the transformative way that is the outcome of appropriate and well-timed interpretation. Schore comments that affectively focused treatment can ‘literally alter the orbito-frontal system of the brain’ and suggests that ‘non-verbal transference-countertransference interactions that take place at preconscious-unconscious levels represent right hemisphere to right hemisphere communications of … emotional states between patient and therapist’ (Schore 2001b, p. ).
At the beginning of therapy the greatest need may be for containment with the therapist as the container of uncontainable affect of unbearable experience, and also as the one who can process the rapidly changing dynamics of the transference and countertransference in order that what feels like ‘now’ may settle into ‘then’. There will be a need for meaning making, for naming that which was previously known only in the body, unavailable to the mind. Early relational trauma may give rise to vertical splits within the personality, experienced as alternating subjectivities, at the very least there will be the frightened, angry child whose development was stopped by the experience of overwhelming trauma and whose emergence in the consulting room will mark the first tentative steps towards trust. One might say that part of successful therapy will be the recognition of the threesome in the consulting room, that is the analyst, the patient who manages the day to day more or less successfully whether adult or child, and the inner hurt part of the patient that is often characterized as the traumatized child within The skill of the analyst is to relate to both without favouring one or the other so that the two may become more able to interact in a caring way one with the other, eventually becoming more wholly integrated into one, allowing a new experience of the self.
The questions surrounding the recall of memory and accuracy of memories that surface in the consulting-room have been widely discussed; however we should also be aware of the way in which the changing of emotional memory may actually be a benign aspect of analytic work, in that the re-telling (from explicit) or re-experiencing (from implicit) of memories in the presence of the therapist may lead to a modulation in the quality of the affect associated with the memory, thus modifying the memory. Siegel notes that recent studies of flashback conditions suggest an intense activation of the right-hemisphere visual cortex and an inhibition of left hemisphere speech areas’ (2003, p 15) At such moments much will depend on the calm that the therapist is able to sustain within in the face of much that urges consciously and unconsciously towards just the opposite. A lowering of tone and slowing of speech, speaking in what Williams (2004) has termed ‘pastel rather than primary colours’ may help to counteract the responses triggered in the patient. It may be possible to help the patient to modify their experience by use of a simple phrase such as ‘it was then, not now’. Cozolino (2002) suggests that this is effective because it stimulates Broca's area and encourages the functioning of right and left hemispheres in a more integrated way.
This process of cure is not only that of making unconscious conscious, with interpretation, but also the interactive experiencing within the therapeutic dyad. It is the combination of the two that enables change. The development of regulated of affect within the patient brings with it the capacity to reflect, that then makes more possible the interpretative moment, in turn bringing with it the possibility of more integrated hemispheric functioning and the development of coherent narrative. Fonagy argues that ‘the ability to represent the idea of an affect is crucial in the achievement of control over overwhelming affect’ (Fonagy 1991, p. 641). For this to occur successfully interpretation; must be grounded in the emotional experiencing that occurs within the therapeutic dyad rather than being merely cognitive engaging primarily the left hemisphere alone. Beebe and Lachmann describe the analytic process as ‘a co-constructed interactive process’ in which ‘the narrative dynamic issues and the moment by moment negotiation of relatedness fluctuate between foreground and background’ (Beebe & Lachmann 2002, p. 17).
The work in the consulting room, with its focus on the transference, calls forth emotional responses that come from implicit, emotional, amygdaloidal memory traces that affect profoundly the individual's way of experiencing and relating to others. The more traumatic the early experience of the patient, the more necessary it is for the analyst to keep this firmly in mind. The therapist's way of working, of containing and moderating the affect evoked, will determine whether an experience ‘kindles’, that is, activates an emergency response where no emergency is, releasing a toxic soup of chemicals in the brain and retraumatizing the patient, or whether it facilitates the ‘quenching’ process which then permits analysis of the transference. Such work enables the later left brain analytic processing, that ‘allows for the structural expansion of the patient's orbito-frontal system and its cortical and subcortical connections’ (Schore 2001a, p. 72) and strengthens cortical control over the amygdala (LeDoux 2002)." (pp. 490-492)
Margaret Wilkinson (2005). Undoing dissociation. Affective neuroscience. Journal of Analytical Psychology, Vol. 50, pp. 483-501
