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CHAPTER FIVE: Reminiscing and recollecting

Norbert Freedman Karnac Books ePub

Jamieson Webster and Norbert Freedman

Let us revisit the Effectiveness Study where we encountered ten patients who elected to speak to Dr V, an analyst, about their earlier experience in treatment. The group had been divided in half with respect to their scores on the Effectiveness Questionnaire: five patients experienced the treatment as satisfactory and the other half reported a sense of dissatisfaction. Once more, we ask the question: what is meant by effective treatment?

In further studies of these patients and their recall narratives with Dr V, the division five and five holds over a number of telling categories with satisfaction correlating with measures of reflective functioning (Fonagy, 1995), secure attachment (Roy, 2007), absence of annihilation anxiety (Hurvich, 2002), and high referential activity, as measured by the referential process (Bucci &Maskit, 2007). One might conclude that satisfaction with therapy is a good quantitative indicator of the success of a treatment with all the concomitant benefits: more secure attachment to the therapist, decrease in anxiety, a widening of one's self-reflective capacities, and so on and so forth.

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Chapter Five: Breakdown and recovery in the analysis of a young woman

Andrew B Druck Karnac Books ePub

Aaron Thaler 1

Breakdown phenomena and related symptoms are common features in psychoanalytic treatment dealing with severe disturbances of continuity and ego-integration. The first part of this paper traces ideas about breakdown and recovery mainly through review of Winnicott's work in this area. The second part describes a period of breakdown that occurred during an advanced stage in the analysis of a very courageous young woman, Ms R. This period, which Ms R came to refer to as “my breakdown,” involved two years of reliving continuous, almost unbearable anxiety, disorientation, and pain which seemed to have been carried from her early childhood. The description focuses especially on a series of transference dreams produced over the course of one year that reflect Ms R's working through these powerful early anxieties on the way to important growth, symbolization, and recovery.

Although it is outside the scope of this paper, readers may look into illuminating papers by Clare Winnicott (1980) and Judith Mitrani (1998) who also applied Winnicott's ideas to examples of breakdown phenomena arising in the course of psychoanalytic treatment.

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CHAPTER SEVENTEEN: The cycle and the spiral during the re-symbolizing phase: the erotic transference, the extraordinary countertransference, and the preservation of the analytic process: session

Norbert Freedman Karnac Books ePub

Norbert Freedman and Rhonda Ward

Session 257 represents a stellar moment in this specimen of working through. It is an unambiguous symbolizing hour, marking a return to symbolization and the completion of the transformation cycle. But it is more than this, for it not only contains the highest level of symbolization in this cycle (as reflected in the peaking of referential activity measures), but it also contains the highest levels of non-integration (as reflected in low measures of interactional synchrony). Thus, this session not only completes the cycle but in its peaks and troughs has the properties of a spiral.

Furthermore, this session contains within its structure all the phases of this transformation cycle, that is, a phase of symbolization, desymbolization, and re-symbolization. In the broadest sense, this replication allows us to translate and revisit the specific way-stations encountered in this specimen. The symbolizing phase of this session reveals paradoxically a downward slope and with it the induction of regression reverberating in the transference (Chapter Fourteen); patient-induced and analyst-induced enactments, resulting in a moment of mutual enactment, reflect a peak of desymbolization and paradoxically initiate the upward slope (Chapter Sixteen); and finally, a nodal moment at the end of the session results in a reversal and a return to symbolization (Chapter Fifteen).

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Chapter Eight: Ferenczi's concepts of identification with the aggressor and play as foundational processes in the analytic relationship

Andrew B Druck Karnac Books ePub

Jay Frankel

I understand clinical psychoanalysis as a process of symbolizing experiences that have thus far been too imbued with fear or anxiety to allow them to be thought about. Symbolizing these experiences allows them to be held in mind, considered, tested against ongoing reality, placed into some realistic and workable perspective, and integrated into the personality. As this happens, new patterns of thinking, feeling, and perceiving can emerge. Given the right conditions, symbolization is a natural activity of the ego. Thus, the clinical challenge of psychoanalysis is to create conditions that allow the symbolization of excluded experience to occur.

Such conditions, designed to invite the patient's experience into the analytic space in a vivid way, include a situation that does not impinge very much on the patient's experience and that offers an unusual degree of freedom of expression of thoughts and feelings by the patient, and an analyst who can be felt to be essentially benign, dependable, and emotionally resonant.

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CHAPTER SIXTEEN: The enactive phase: sessions 252 to 255

Norbert Freedman Karnac Books ePub

Norbert Freedman and Rhonda Ward

Almost immediately following the nodal moments of the desymbolizing phase, there appeared a sequence of sessions which we could not classify as either A or Z, and were, thus, neither predominately symbolizing nor desymbolizing sessions. Even more striking was another “objective fact”, alerting us to a potentially informative event: during these sessions, the analyst's scans increased in length. This could mean that the patient had more to say and/or that the analyst was more engaged, but whatever the interpretation, there was a veritable surge of analyst's comments at this point. During the desymbolizing phase, the length of the analyst's scan (expressed in words spoken) was for session 245, 247, and 249, 555, 719, and 452 words, respectively. For sessions 252, 253, 254, and 255, the word output was 823, 1010, 1003, and 709, respectively. Noteworthy is that the scan for session 257, an unambiguous A session and the last of this specimen, had a word count of 1475. From the vantage point of referential activity, there also appeared to be an upward trend: the RA score for session 252 was 0.449 and for session 255, 0.467. It seemed we had entered a new phase in the analytic process, be it patient activity or analyst engagement. Perhaps we were, to use Palombo's memorable metaphor, “[At] the edge of chaos when a small change in input from the environment can lead to a reorganization of the system's structure at a level of increased complexity” (1999, p. 175). Perhaps the upward slope involves a process of differentiation occurring only “at the phase transition between frozen ice and chaotic fluid states” (ibid., p. 176).

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