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Time Present and Time Past

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This remarkable collection of papers is divided into three sections: clinical issues; psychoanalysis and the life cycle; and underlying theories of practice. The papers span the years 1951 to 2004, recording five decades of British psychoanalysis, through various angles. Pearl King's outstanding contribution to British psychoanalysis has shaped the psychoanalytic community in this country as it is today, and the papers in this volume chart the progress of the author as a psychoanalyst, with the background of various important events in the psychoanalytic community.The papers in the clinical part include a unique, lengthy case study of the psychoanalysis of a four-year-old boy, and a follow-up of his life over five decades later. After reading the paper at the age of 54, the patient agreed to write his own version of his life, which is included in the book. The second part of the book, on psychoanalysis and the life cycle, includes renowned chapters on ageing. The author looks at the ageing psychoanalyst as well as the characteristics of analysis with older patients. The third part discusses the theories underlying Pearl King's practice and puts forward her views on such concepts as alienation, transference, and the importance of time in psychoanalytic work with patients.

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1. Change: the psychoanalysis of a four-year-old boy and its follow-up

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In December 1951, I received a letter from Dr Donald Winnicott to say that he had seen a 4-year-old-boy at Paddington Green Children’s Hospital and he would like to refer him to me. If I would like to take him on, the case could be started immediately. The child had been referred to him by a colleague, who wrote:

“Philip saw his younger brother, age 2, fall out of a window (August this year). The fall killed the brother and Philip witnessed the whole scene. Since then he has been very disturbed and started to stutter. He is also becoming extremely aggressive towards his mother and at the same time demanding a lot of love. He has also developed a peculiar way of covering himself up with a waterproof sheet and lying quite still. Perhaps he is the dead brother when he does this.”

It was a tragic case, and I told Winnicott that I would be happy to work with this little boy if Winnicott would work with me. Dr Winnicott explained to me what happened as follows: “Philip”, aged 4, had a brother, “Steven”, aged 2. Philip was playing in the garden, cutting up worms, and he called for his younger brother to join him. His younger

 

2. Experiences of success and failure as essential to the process of development

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The idea of talking about this theme came to me while I was listening to a patient trying to sort out his feelings about success and failure. Some weeks previously, he had agreed to give a conjuring show at a dinner party, and on the evening of this session he had to fulfil this commitment. He was consumed with anxiety and resentment about it. It occurred to me that he was in a situation with which many patients are familiar and that such experiences of dealing with success and failure are part and parcel of the whole process of growth and development. Patients wish so much to experience some success, yet they become so paralysed by anxiety at the crucial moment that what they so desire, and what their friends so often desire for them, becomes unattainable. So that even in situations where the environment is helpful and encouraging, they remain crippled and immobile.

It is, of course, a matter of common experience to become anxious before a test of one’s abilities (particularly when it may involve failure). In everyday language, this is expressed in terms of fear of injury to one’s self-esteem. In psychoanalytic terms, such anxiety can be described as a threat to the individual’s potency and narcissism, as well as to his feelings of security. Although this is one possible way of looking at this kind of situation, it seemed to me to be a very inadéquate pointer to what I felt was the immediate concern of this patient during this particular session. I shall now give some more details about him, in the hope of making my point more clearly.

 

3. The curative factors in psychoanalysis

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There are some themes in psychoanalysis which it is not possible to delineate and discuss with any feeling of satisfaction that we have encompassed their most important aspects and have achieved some form of gestalt in our presentation. It seems to me that “The Curative Factors in Psychoanalysis” falls into this category. Nevértheless, the topic raises such vital issues that it is well worth discussing periodically, and re-evaluating the hypotheses on which we base our work.

While the main speakers have selected different aspects of this theme, they all appear to recognize the central importance of the fact that it is in the quality of the analytic situation that “cure” resides. This “quality” they all relate to the attitude of the analyst to his relationship with his patient. Where they differ is in their definition of what this attitude should be.

I find myself basically in agreement with the approaches of Gitelson and Segal on this point, and in disagreement with many of the formulations of Nacht. I must, however, express my gratitude to Nacht, whose paper provoked me to re-think some of my own ideas on this subject.

 

4. The therapist–patient relationship

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One of the problems that face those involved in psycho-therapeutic work with patients is that they tend to accept as given certain theoretical assumptions on which their techniques are based, and sometimes these are not even formulated. It is easy to see how this can happen, as psychotherapeutic techniques— and more particularly if they have produced good results—so easily become part of oneself.

I therefore welcome the opportunity to take part in this conversázione because it has made me try to look at what I and other psychoánalysts do, from the standpoint of colleagues with whom I may not always have agreed in the past.

I regret that there are not more opportunities for a dialogue between us, as we are all engaged in exploring problems of the human psyche and in attempting to relieve or cure human pain and mental suffering. In fact, Jungians and Freudians, according to popular stereotypes, are often placed on opposite poles of a dichotomy. I will not attempt to describe these stereotypes, but what has struck me in the course of the reading I have done, in order to write this paper, is that with the enlarging of our professional and cultural frames of reference, some points of dissension between Freud and Jung now look very different in the light of our current knowledge and experience.

 

5. On a patient’s unconscious need to have “bad parents”

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In the late 1940s I was asked by Paula Heimann to summarize for discussion at a seminar the main points in Freud’s paper on technique, “Recommendations to Physicians Practising Psychoánalysis”. When I came to the recommendation that analysts should take as a model “the surgeon, who puts aside all his feeling, including his human sympathy, and concentrates his mental forces on the single aim of performing the operation as skilfully as possible” (Freud, 1912e, p. 115), Paula Heimann, to my surprise, strongly disagreed with Freud’s emphatic recommendations. She formulated her point of view later in the paper entitled “On Countertransference” she read in 1949 at the 16th International Psychoanalytical Congress. In this paper she stated that “My thesis is that the analyst’s emotional response to his patient within the analytic situation represents one of the most important tools for his work. The analyst’s countertransference is an instrument of research into the patient’s unconscious” (Heimann, 1950). While accepting that the analyst must avoid the danger of becoming preoccupied with any one theme, and must maintain an evenly hovering attention in order to follow the patient’s free associations so that he can listen simultaneously on many levels, she suggested “that the analyst along with this freely working attention needs a freely roused emotional sensibility so as to follow the patient’s emotional movements and unconscious phantasies”. Her assumption is that the analyst’s unconscious is an important instrument for understanding the subtleties of the patient’s unconscious. She wrote: “This rapport on the deep level comes to the surface in the form of feelings which the analyst notices in response to his patient, in his ‘countertransference’. This is the most dynamic way in which his patient’s voice reaches him. In the comparison of feelings roused in himself with his patient’s associations and behaviour, the analyst possesses a most valuable means of checking whether he has understood or failed to understand his patient” (Heimann, 1950). She particularly emphasized the importance of those feelings that the analyst experiences when there is a discrepancy between the analyst’s conscious understanding of the patient’s communication and his unconscious perception of the patient’s unconscious processes.

 

6. The affective response of the analyst to the patient’s communications

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I notice with interest that the writers of the three pre-published papers (Arlow, 1977; Green, 1977; Limentani, 1977) were not able to deal with the topic of affects by focusing only on the conceptuálization and role of the affects in the patient’s psychopathology—that is, as a one-person psychology. All three commented in different ways that in the psychoanalytic situation, affects have a two-way function. As Rycroft (1956) has pointed out, one of the peculiarities of affects is that they are felt by others and that they induce, or are expected to induce, in others identical or opposing affects. They cannot therefore be experienced by the patient without the analyst becoming, in some way, involved with them and aware of them. How he becomes aware of them and what use he makes, if any, of his awareness brings me to the theme of this paper.

Green (1977) has drawn attention to the tendency of the British School, following Marjorie Brierley (1937), to tie primary affective development to object relations and to work in terms of “object cathexis rather than affective charge of ideas”. This cathexis is assumed to precede differentiation and cognitive discrimination. This approach to the understanding of affects gained support from the work of Middle-more (1941) and Winnicott (1945, 1950, 1951), who both made studies of early mother-child relationships, which focused on the importance of the mother’s role in the primary affective development of the infant, emphasizing that the infant cannot be considered in isolation from the mother (or a mother substitute), without whom it could not survive. Our understanding of the infant’s early affective development was further enhanced by other studies of the mother–child relationship through systematic infant observation during the first year of life, following the publication of Bowlby’s (1951) survey for the World Health Organization of the effects of maternal deprivation on child health.

 

7. Sexuality and the narcissistic character

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Introductory comments

I have been asked in this paper to focus on a number of theoretical questions relevant to the topic of the Conference, and this I have attempted to do. The task of having to study the relevant literature has shown me that the concepts of primary and secondary narcissism have evoked much controversy. Some analysts have discarded the concept of primary narcissism altogether, while others use it merely descriptively (Jacobson, 1964). There are also those who replace it with terms such as “primary love” (Balint, 1960, p. 6).

Most analysts accept the usefulness of the concept of secondary narcissism and the idea that some individuals cathect aspects of themselves with narcissistic libido following the withdrawal of object-libido and de-cathexis of significant objects in their external relationships. The increasing use of the terms “narcissistic character” and “narcissistic personality disorders” indicate further the usefulness of the concept of narcissism. Freud found that when a patient had withdrawn his object-libido from external objects and had become unable to cathect them, they became extremely difficult to treat by the methods he used, which depended on the re-experiencing in the analysis of the early emotional and instinctual relationships with parents and other significant figures.

 

8. “For age is opportunity no less than youth itself”

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Soon after I qualified as a psychoanalyst in 1950, I, together with a group of colleagues who had trained with me in the British Psychoanalytical Society, approached Hanna Segal with the request that she run a clinical discussion group for us. The group included Harold Bridger, Tommy (A.T.M.) Wilson, and Elliot Jaques, all of whom worked at the Tavistock Institute of Human Relations, where I had also worked during some of my training. It was during this period that I first got to know and work with Segal.

The atmosphere in these clinical discussion groups was lively and enthusiastic, as one would expect from colleagues who had recently qualified as psychoanalysts and who hoped that their recently acquired skills and ways of understanding mental problems would enáble them to help whoever approached them for treatment, however ill they were—and some of the patients that we discussed were very disturbed. I think that our approach was that if psychoanalysis could not cure them, it could at least improve their condition.

 

9. The life cycle as indicated by the nature of the transference in the psychoanalysis of the middle-aged and elderly

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I think that I am correct in believing that this is the first time a programme committee has arranged for a paper dealing with the psychoanalysis of middle-aged and elderly patients to be given at an International Psychoanalytical Congress, and I am aware that I cannot assume that all psychoanalysts will agree that such patients are suitable candidates for psychoanalysis. I have therefore decided to leave this chapter as though I were presenting it to members of the first IPA Congress to be held in the United States of America, in New York. Freud did not initially encourage psychoanalysts to analyse the elderly, and for many years both psychoanalytic theory and reported cases have tended to be concerned with problems of patients in the younger age range—that is, up to 40 years of age—and the psychoánalysis of patients over that age was not recommended, ageing often being used as a contraindication for psychoanalysis. However, in his paper “Types of Onset of Neurosis”, Freud (1912c) discusses the possibility that developmental biological processes may produce an alteration in the equilibrium of the psychic processes, thus producing neurotic breakdowns at key phases of the life cycle at puberty and the menopause. He also describes “falling ill from an inhibition in development” (p. 235, emphasis added).

 

10. On becoming an ageing psychoanalyst

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I began to be interested in the impact of ageing on patients and colleagues—and, of course, on myself—after I had presented a paper on “Sexuality and the Narcissistic Character” at the Weekénd Conference of English Speaking Members of European Societies in 1972.

I was discussing the analysis of an elderly patient, well over 60 years old, with some French colleagues, and they stated quite confidently that it was not possible to analyse anyone over 40 years of age. This comment, of course, challenged me to explore the attitude of Freud and his contemporaries to the question of the relevance of age for the success of an analysis.

The result of my explorations was that I read a paper to the Society of Analytical Psychology on 15 January 1973, on “Notes on the Psychoanalysis of Older Patients: Reappraisal of the Potentialities for Change during the Second Half of Life” (King, 1974b). I went to the Jungians as I had read some of Jung’s comments on this topic and I thought that they would not be so dogmatic about discussing ageing as some of my psychoanalytic colleagues had been. The Jungians published my paper in their journal in 1974.

 

11. “In age I bud again”—achievements and hazards in the analysis of older patients

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Psychoanalysts usually have only a few, if any, older patients in their practices during the span of their working lives, so it is important to share our experiences, to compare what can be achieved, and to speculate on the reasons for these achievements. It is also important to consider any hazards and to delineate the limitations of psychoanalysis as applied to older patients.

What are some of the pressures that bring older patients to seek psychoanalysis? Many people feel that at middle age they get a second chance to evaluate themselves before facing retirement, old age, and death, and they look to psychoanalysis to help them in this process. Pressures arising from changes in their life cycle brought on by the menopause or the male climacteric confront them with the need to evolve a new and age-appropriate way of being alive. Or they may be suffering from some more specific symptoms or neurotic illnesses, which they had not taken seriously before, hoping that time would remove them, but now they see their retirement and old age threatened by these illnesses and thus they, too, may seek psychoanalysis.

 

12. Alienation and the individual

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The idea of considering the meaning and usefulness of the concept of alienation arose when a group of social psychologists were discussing the process of socialization. In the course of this discussion, they attempted to look at what happened when this process failed. Was it a failure of society or of the cultural subgroup to transmit the skills, norms, and values necessary for an integration of the person into the community to take place? Or was there some personality inadequacy in the individual that led to the failure of the socialization process? Was it that society was making inappropriate demands on the isolated or asocial individual, or had there been some failure in the individual’s developmental experiences that had made it impossible for him to relate meaningfully to others or to himself?

The trend of the discussion seemed to indicate that the problem was being approached in a triangular manner. If A was the isolated individual, he was being clearly demarcated from B, the group or community of “socialized” individuals, and then slightly apart, and watching both A and B, there was C, the social psychologist. This triangular approach or frame of reference initially appeared to be a reasonable one to adopt, and one from which much could be observed, hypothésized, and operationally tested out and measured. It seemed less adequate when the question was asked: “How does A, the individual, feel about his situation, and how does he experience himself and others?”

 

13. Time and a sense of identity

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I first started thinking seriously about the problem of identity and alienation of the self after reading The Quest for Identity by Allen Wheelis (1959), when I thought that he was describing a problem that psychoanalysts ought to take seriously. His complaint appeared to be that it was possible to go through many years of analysis and psychoanalytic training and to end up without any feeling of being a person who has his own core of inner experience and is able to contact an inner source of creativeness often enough over a period of time to feel that he is a viable human being (Erikson, 1956), enriched by his relationships and activities and not alienated from any inner source of replenishment. This complaint of alienation from oneself and the fruits of one’s actions has become an increasingly frequent reason why many people seek analysis. It is as though they can only live in the present, but they have cut themselves off from their past and their inner roots, so that they cannot perceive a future for themselves!

 

14. The timing of interpretations of transference and interpersonal relations in psychoanalytic therapy

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I would like to consider this event as a workshop in which we can share our experiences and consider the advantages, difficulties, and consequences of different theoretical standpoints and technical procedures for understanding and dealing with the patient–analyst relationship in psychoanalysis.

As I have been trained in the British Psychoanalytical Society, with its tolerant attitude to different approaches to psychoanalytic techniques, I tend to take for granted that analysts with different theoretical frames of reference, arising from different interpretations of Freud’s writings and of their clinical experience, with consequent variations in technique, will, at some time, have good clinical results. But what I have found difficult is to get a setting in which it is possible to look at the different patterns that the therapeutic process takes, consequent on the adoption of variations of transference phenomena at different stages of an analysis.

I would like particularly to look at the theories behind the timing of interpretations concerned with the patient’s feelings, thoughts about, and behaviour towards the analyst, at different phases of an analysis, and the way these influence not only what can be dealt with, but also what is left out, as well as the therapeutic outcome.

 

15. The supervision of students in psychoanalytic training who have previously been trained as psychotherapists

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I was first invited in 1955 to take part in the training of psychoanalysts in the British Society. At that time it was made quite clear to us as training analysts that we should only accept as patients, who wished to be trained as psychoanalysts, those accepted as psychoanalytic students by our Training Committee and that we should not take part in “training arrangements” for any of the Psychotherapy Training Courses (BAP) that were being started. Prior to the war, applicants who worked at the Tavistock Clinic were told that they had to give up their work at the Clinic if they wanted us to train them as psychoanalysts, in order that those accepted for training could keep their experiénce of psychoanalysis separate from the psychotherapies that were practised there. One result of the Second World War was that members of both organizations—the Institute of Psychoanalysis and the Tavistock Clinic—who had worked together during that war made friends and sorted out their roles to their mutual advantage.

 

16. On being a psychoanalyst: integrity and vulnerability in psychoanalytic organizations

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On a huge hill,
Cragged, and steep, Truth stands, and he that will
Reach her, about must, and about must go;
And what the hill’s suddenness resists, win so;
Keep the truth which thou hast found

John Donne

These words by the seventeenth-century English poet John Donne, which appear in his poem “Satire III” (1931), made a profound impression on me when I first came across them as an undergraduate in the 1930s. I was keen to oppose the growing power of the Nazis and frustrated that the British authorities did not seem to see the truth of what was happening in Germany or, if they were aware of what was taking place there, were doing little to oppose or impede it. With the enthusiasm of youth, truth seemed so simple, and I felt right was on the side of my own version of truth. But the lines quoted above pointed in another direction. They confronted me with the necessity to struggle to discover truth and with the painful fact that this discovery of the truth does not come easily.

Since then, and especially in my work as a psychoanalyst, I have realized the importance of Donne’s words. To discover what is true, one has to see an issue from many vantage points, each of which may add to or change one’s perception of it, until one can reach the apex of the “huge hill, cragged, and steep” where “Truth stands”. Only then can one integrate all facets of that truth for which one searches and feel it match an inner core of rightness. Then, to keep the truth that we have found, is to be true to our own inner sense of integrity. In The Mind of Watergate: An Exploration of the Compromise of Integrity (1980), Leo Rangell delineated the events that took place in the United States that led eventually to the resignation of President Nixon. Using his psychoánalytic understanding, he described some of the conscious and unconscious individual and group dynamics that facilitated the evolution of the behaviour of those involved.

 

APPENDIX: Questions to ask (myself) about a patient’s material

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What is the setting of this session? (Must see each session as a continuation of a process. These questions are in the nature of tuning-in to a patient’s wave-length.)

(a) What was the theme of the last session?

(b) What role did the patient put me in, and what intrapsychic conflicts were being transferred from the past to the psychoánalytic situation?

(c) What level of material were we dealing with?

(d) Was there anything left over from the last session that I ought to try to take up, if a suitable opportunity occurs?

(e) What is the reality situation, including relation to holiday or the week in relation to weekends, anniversaries, etc.?

1. Limitations of questions. Useful as a check to our analytic work as well as a guide when we are not sure what is the most dynamically important happening at the moment.

2. Remember always to think in terms of the manifest or conscious aspects of what the patient is saying, and the latent or unconscious aspects of it. It is always the latter that we are after!

 

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