Shared Experience: The Psychoanalytic Dialogue

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This book presents a way to formulate, from several points of view, "Psychoanalysis as an encounter between two persons", and highlights the aspects of symmetry and affective exchange of this encounter where analysis is seen as a relationship between two minds. In this shared experience the study of the mind of the Analyst and of his method of work grows in importance as the source of benefits and misdirections which can be exchanged in the encounter with the patient.In this context, the patient has an active role as an attentive and sensitive observer of the Analyst, signaling errors and showing the road to be taken. This change in the concept of psychoanalysis has evolved through many years; from the Analyst acting to open the patient within himself, while at the same time struggling against his own resistance to change, to a vision of a "Couple at Work". Psychoanalysis is now a "shared experience", in which the listening and creating of internal space to the other, within the self, is the instrument and the journey.The aim of analysis is not the discovery of hidden truths, but rather the recover of alienated areas, new beginnings of natural development, and the construction of new meanings.The editors and contributors, all from the Centro di Psa Milanese, are members of the Italian Society of Psychoanalysis and of the International Psychoanalytical Association. 'In this volume the contributors from the Milanese Society show themselves to have gone through their own "growing pains" of psychoanalytic development and arrived at their diverse personal ways of getting closer to dealing with what is thought and felt to be the most important. They have gone through the struggle of slavish devotion to foreign models of psychoanalytic practice and xenophobic rejection of alien viewpoints; they have arrived at distilling that which they considered the most valuable and marrying this to their own thoughtful and intuitive personal understanding.

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1. Two people talking in a room: an investigation on the analytic dialogue

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Luciano. Nisstm Momigliano

Bion describes the psychotherapist’s task as being somewhat similar to that of an officer on the battlefield, who carries on thinking with clarity in the midst of an emotional storm. He states that we can expect this only from someone who has become a “feeling person”—someone who is sensitive and therefore capable of sharing the emotional experience that such a storm provokes, because he has had a “real” analysis and training from a “real” institute of psychoanalysis. When we read this, we, the Italian senior analysts, look at each other and shake our heads. Of course, we think, this is just what we are trying to provide for our young colleagues, even if it implies a strictness that is not universally appreciated. On the other hand, we have to acknowledge that in Italy at the time when we applied to become psychoanalysts, our society was still in its pioneering stages: it welcomed us affectionately without imposing any rigid terms, and therefore without subjecting us to the restrictions of a “real” school. This, I believe, was in its way fortunate, since it encouraged us to seek new opportunities to meet and to read and so find food for thought in the most varied sources. In this way we could not become fossilized on past acquisitions. So we, too, have been engaged on a lengthy march, of which I will not list here the various stages since I hope that we are all still on our way. But how exhausting it is! We must contend continually with our own sincere desire for quiet. Freud had to learn this at his own expense. As Hebbels wrote: “Er hat an den Frieden der Welt geruhrt” [he has disturbed the peace of the worldl. And even after him our world continued to be disturbed. In fact, Melanie Klein first and Blon later have gone on upsetting our peace.

 

2. Meeting, telling, and parting: three basic factors in the psychoanalytic experience

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Giuseppe Di Chiara

In meeting, telling, and parting I identify three basic elements, or factors, of any psychoanalytic experience. I believe that the analytic process is the result of their interweaving and interaction and that these elements must always be at work in any experience that is to be considered psychoanalysis. This is, of course, a broad overview and remains to be confirmed by an exchange of experience with other analysts. I reached this formulation through long hours of work in my consulting room and at my desk.

The three factors I have pointed out, which are certainly well known to every analyst, are to be considered a sort of common denominator, an invariable of every analytic experience. Many mental, relational transference-countertransference operations converge there. At the same time a theory about them embraces numerous points of view, models, and theories that have succeeded one another In the course of time. These factors are, In my opinion, the very substance of psychoanalysis rather than an eclectic frame of reference encompassing psychoanalytic theory and practice.

 

3. From a play between “parts” to transformations in the couple: psychoanalysis in a bipersonal field

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Michele Bezoari and Antontno Ferro

To docket living things past any doubt
You cancel first the living spirit out
The parts lie in the hollow of your hand,
You only lack the living link you banned.

Goethe: Faust, part one, p. 95

Bion and the revolution of perspectives

Our clinical-theoretical itinerary takes as its starting point Bion’s revolution of perspective concerning the way the analyst’s mind functions in the session and his attitude in the analytic scenario.

With Bion the analyst’s place is no longer outside the patient’s mental functioning and personal history. Analysis becomes an authentic adventure—a new meeting between two strangers, and the possibility herein of writing a new story out of the many possible ones, according to the reciprocal interaction of the two minds involved in the session and to the extent they are prepared to be open to new thoughts.

Thus the analytic situation can be seen, on the one hand, as symmetrical to the utmost, since in the consulting room there are two frightened people, two fierce, dangerous animals, and the analyst himself is seen as a “mess” while the patient is considered “his best colleague”. On the other hand, the relationship Is asymmetrical to the utmost, since the analyst is wholly responsible for the way the analysis proceeds: he is like an officer who is entrusted with command but shares risks and fears with his men, being himself exposed to the Ps ↔ D oscillations (Bion, 1973. 1978. 1980. 1983).

 

4. The tale of the Green Hand: on projective identification

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Giuseppe Di Chiara

I had known the tale of the green hand since my childhood. In my clinical practice, it appeared during the analysis first of one patient and then later of two others, as an association to a dream in one case, of recalled anal erotism in another, and of anxiety-ridden vicissitudes of anal sadism and masochism in the third. In two of these cases the recalling of the fairy-tale aroused anxiety, and the tale had failed in its aim of making tolerable the psychological experience to which it alludes. The patients remembered it as having been a source of anxiety, when it was told to them as children.

At the beginning I had thought that there might be a correlation between the contents of the fairy-tale and events caused by over-stimulation, as they are described and studied by Shen-gold (1967), but I did not continue along this train of thought. Similarly, I had abandoned the idea of linking the tale with anal masturbation and projective identification (Meltzer, 1966), even if there were a number of clearly possible connections in this sense. But it was Grinberg’s work (1976, 1990) on identification that induced me to take the matter up again.

 

5. Surviving, existing, living: reflections on the analyst’s anxiety

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Dina VaRino Maccio

April is the cruellest month, breeding
Lilacs out of the dead land, mixing
Memory and desire, stirring
Dull roots with spring rain.

T. S. Eliot. The Waste-Land

There is a “cruel” quality to the difficulties of analytic work, to which psychoanalysts more and more frequently give voice, overcoming their reserve and the pride they have in their knowledge. The point in question is the following: to what extent is the analyst, while engaged in his process of understanding, exposed to disrupting anxieties? Facing these anxieties within himself is unavoidable, if the analyst wants to understand and intervene in patients’ mental difficulties. Even though personal analysis and training are sources of inspiration, knowledge, comfort, and encouragement to persevere, analysts can only partially take advantage of their “psychoanalytic” equipment. The analyst at work cannot be protected from the anxieties transmitted by patients by means of either his technique or his scientific knowledge; the quality of understanding is personally endured. Bion’s (1967b) well-known advice to the analyst that he should work without memory and desire indicates how much emotional discipline the analyst must exercise over himself so as to be able to face the unknown transmitted by patients’ experiences. The more the analyst neglects this particular capacity for the assimilation of the confusion and the despair in others’ minds, the more such a defensive stance will render him incapable of understanding and powerless during analysis. The rich store of the psychoanalytic conceptual apparatus will be used rigidly, and an authentic, vital emotional growth relationship with patients will be missing.

 

6. Premature termination of analysis

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Rosanna Gagliardi Guidi

The problem of premature termination of analysis falls within the wider area of acting-out and is intimately connected to issues that the psychoanalytic literature has thoroughly discussed: analysability, transference, counter-transference, negative therapeutic reaction. The development of these issues plays an important role in the history of psychoanalysis.

It is not my intention to retrace the history of these milestones of our science, but simply to examine their connections to the specific subject of my interest. First of all, I would like to highlight something that struck me when I started investigating the problem of premature termination: the attitude taken by analysts towards it. Then I shall make a few considerations of my own and try to sort them out.

The very first thing that attracted my attention was that, as far as I know, premature termination is an event every analyst, sooner or later, has to face; not only do the essays written by many a “master” mention it. but all the colleagues—both Italian and foreign—to whom I put the question as to whether they had any experience of premature termination answered in the affirmative. On the other hand, no one seems to have written anything specific on this well-known subject: the bibliography on the topic is scarce and often only apparently pertinent.

 

7. Negative therapeutic reactions and microfractures in analytic communication

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Francesco Barale and Antonino Ferro

What is a negative therapeutic reaction?

This chapter was conceived in the conviction that a good starting point for a general reflection on clinical experience might be to propose an image of analytic work that approaches everyday difficulties as far as possible. It is precisely work on these difficulties (and an awareness of our limits and setbacks, and those of analysis) that may perhaps give birth to Ideas on the still unexplored aspects of the analytic relation. At the very least we may hope to gain perspective points from which usefully also to reconsider clinical phenomena that, like those we shall discuss, have always been familiar in their overall outlines.

What is meant by a negative therapeutic reaction (NTR) is, at a basic level, well known: the NTR is part of the basic conceptual storehouse of every psychoanalyst and is probably part of his experience as well. But if one turns to the literature, the question quickly becomes more complicated: one finds, in fact. that the original descriptions in Freud (1914c, 1914g, 1923b, 1924c) and Abraham (1919) were followed both by a vast range of ways of conceptualizing and understanding the phenomenon and, consequently, by a considerable extension of its boundaries. Thus, under the heading “NTR” we find descriptions of quite diverse clinical phenomena. Indeed, as Pontalis (1981) notes, having been identified everywhere the NTR cannot be localized anywhere, and the greatest risk is surely that this extension is used to give an entirely nominalistic explanation for any situation of impasse or failure in the analytic relationship, and especially so as to blame the patient: “He dealt me a negative therapeutic reaction!”

 

8. On transference psychosis: clinical perspectives in work with borderline patients

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Franco De Masi

A fundamental aspect of analytic work, in my opinion, Is the capacity that patients have, and further develop in the course of analysis, to grasp and explore the way the analyst functions emotionally and perceptively, to introject this, and to Interact with it. When we are deeply absorbed in our analytic task, we may find it difficult to determine whether the patient’s introjection occurs on the basis of correct perceptions or under the influence of past experiences or of primitive internal objects. Internal objects may interfere with a good Introjection and seriously distort the image of the analyst and the perception of the analytic relationship. Correct and distorted introjections frequently interact, and it is fundamental to help the patient to discriminate between adequate perceptions and possible conscious or unconscious distortions. Generally speaking, only when the analyst repeatedly gives distorted answers to the patient’s communications (which often concern the analyst’s way of interacting) can an impasse occur, and that may, unfortunately, lead to a premature termination. The patient is usually able to signal his difficulties, and it is therefore essential to pick up these indications, recognizing them as important contributions. In other words, I would like to emphasize how important it is that the analyst accept his share of responsibility and free himself of an immovable, idealized image of his role and of the analytic process. I argue that good receptivity on the analyst’s part allows the patient to develop his capacity to explore and understand both his own psychic reality and that of others.

 

9. Cassandra: a myth for hypochondria

ePub

Andreina Robutti

… by friends turned enemies,
mocked without doubt in vain.

Aeschylus, Agamemnon

Myth is a great collective dream, a creation unfolding meanings, which, like individual dreams—our private myths—can turn out to be a precious tool in the search for knowledge. Through the words of some patients, Cassandra slid into my consulting room and prompted thoughts on hypochondria, a rather enigmatic event. The brief appearances of the unbelieved seer in the accounts of mythologists and poets, together with psychoanalytic literature, have supported me in working through my patients vicissitudes and my own experience with them.

I think that the hypochondriac, like Cassandra, speaks about a truth that is never believed. I also think that this myth, which represents a painful series of insurmountable misunderstandings, tells us not only about a relational failure, but also about an internal fracture, a loss of contact with knowledge and with meaning. I shall now Illustrate this hypothesis.

In myth, Cassandra Is not always the disbelieved prophetess. This is how Homer sketches her In the Iliad:

 

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