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CHAPTER FOURTEEN: The induction of transference regression during the symbolizing phase: sessions 232 to 243

Norbert Freedman Karnac Books ePub

Norbert Freedman and Rhonda Ward

In 1950, Macalpine published a memorable paper on the nature of transference, in which she asserted that a regressive transference is not only inevitable, but is evoked and actually induced by forces inherent in the frame of the psychoanalytic process. For us, the regressive transference is a paradoxical situation in which the patient may feel received, even supported, yet at the same time confronted by an enigmatic force that pulls in a downward direction. This precise situation was encountered by Ms Y during the symbolizing phase of this transformation cycle.

Macalpine's statement, based on an extensive review of the cumulative psychoanalytic knowledge up to 1950, raises for us two fundamental issues deserving separate consideration. The first concerns what we might call the induction hypothesis, the other we will call the reverberation hypothesis. Regarding the induction hypothesis, Macalpine spells out a series of specific transference forces, mobilized by the explicit and implicit analytic frame, which activate a pull towards a lower level of mental organization. This implies a paradoxical situation: the patient experiences an enigmatic force, pulling in the direction of lesser differentiation, and occurring at the very point of feeling heard and received. In the reverberation hypothesis, what we call regression is not only experienced by the patient, but is also communicated to and experienced by the person of the analyst, lending depth to analytic work.

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Chapter Nine: Cultivating meaning space: Freudian and neo-Kleinian conceptions of therapeutic action

Andrew B Druck Karnac Books ePub

Neal Vorus

This chapter attempts to address the following question: how does change take place in psychoanalysis, from a contemporary Freudian perspective?

One might think that the answer to such a central question would be rather obvious. In fact, it is remarkably complex and difficult, and likely to be answered in different ways depending on whom you ask. Possible answers include: “making the unconscious conscious;” “learning to self-reflect;” “integrating split-off aspects of personality;” “achieving personalization of self;” “internalizing a good object;” etc. One explanation of the proliferation of these ideas is that it simply reflects the range of pathology that one meets in clinical practice; different patients need different cures. No doubt there is truth to this; it would be remarkably reductionist, and counter to honest clinical experience, to assume that everyone uses treatment in the same way in order to achieve the same results.

However, there is a second factor that this chapter aims to address, and that is the longstanding bifurcation between insight and relationship as curative factors. While there has not always been a contentious divide between these factors in psychoanalysis (see Friedman, 1978b), for the past 50 years or so this has been perhaps the most politicized of therapeutic issues. In this chapter I will briefly review the history of this theoretical divide, then suggest that a path towards common ground on the issue lies in the recent rapprochement between contemporary Freudian and Kleinian thought, particularly as represented in the writings of Ron Britton. Towards the end of the chapter I will present a clinical example to illustrate an application of a contemporary Freudian approach, informed by neo-Kleinian perspectives.

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CHAPTER TEN: Transformations in long-term psychoanalytic psychotherapy: the case of Ms K

Norbert Freedman Karnac Books ePub

Rhonda Ward, Norbert Freedman, and Marvin Hurvich

In the two preceding chapters, it has been shown how a patient's psychic functioning can reorganize dramatically in diverse directions with the presence of Annihilation Anxiety. It was noted in Chapter Eight how, within the first four weeks of psychotherapy, Mohamed, a severely traumatized patient, revealed such a transformation. His telling of extreme torture, at first desymbolized and concretized, appeared within a new context during active transference engagement. This was a transformation arising through a symbolized transference.

In Chapter Nine, a clinical regression was described and an alteration in the opposite direction was noted. During the “eye of the storm”, the panic attack proper, there arose an accentuation of Annihilation Anxiety, a regressive transformation, creating experiences of psychic blankness. Under these conditions of helplessness, thinking came to a halt. As an epilogue to this second pathway, a fleeting moment of recovery appeared in conjunction with a coun-tertransference enactment, thus depicting the nonlinearity inherent in psychic transformation.

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Chapter Three: States of consciousness

Andrew B Druck Karnac Books ePub

Sheldon Bach

We all think we know the difference between being awake and being asleep but that is, among other things, the difference between two states of consciousness. When we wake up or go to sleep we have altered our state of consciousness. We can also alter our state of consciousness by taking drugs that lower our state of excitation or drugs that raise our state of excitation or drugs that are hallucinatory; or by exercising (endorphins), by falling in love or having sex, by meditating, by getting angry, by being in isolation or being inebriated, by fading out listening to a boring lecture or by getting enthusiastic about an exciting one. You can see that almost anything we do may involve changes in our state of consciousness.

It is also clear that we often react to people and describe them by their apparent or publicly visible states of consciousness: “He's a space cadet,” “He's so uptight,” “She's a dizzy dame, out to lunch,” etc. I believe that some diagnostic categories are abbreviated descriptions of certain characteristic states of consciousness, and more than 30 years ago I wrote an elaborate description of the narcissistic state of consciousness, some elements of which have been paralleled by the DSM IV diagnosis (Bach, 1977). But when we try to actually define what we mean by a state of consciousness, we run into considerable difficulty.

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Chapter Four: New developments in the theory and clinical application of the annihilation anxiety concept

Andrew B Druck Karnac Books ePub

Marvin Hurvich 1

My interest in annihilation anxieties (AA) goes back to a 1980 clinical observation that recalcitrant symptoms in more disturbed patients are often underlaid by defended anxieties concerning annihilation and threats to survival. Analytic scrutiny revealed that these anxieties included apprehensions of being overwhelmed, dissolved, invaded, or going insane. In addition to constructing a research instrument to measure the extent of these anxieties in clinical populations (Benveniste, Papouchis, Allen & Hurvich, 1998; Hurvich, 1989; Hurvich, Benveniste, Howard & Coonerty, 1993; Hurvich & Simha Alpern, 1997; Hurvich, Allen, & Mcguire, 2006a; Levin & Hurvich, 1995), I embarked on an intensive study of the psychoanalytic literature that revealed a consequential incongruity concerning annihilation fantasies and anxieties (Hurvich, 2003). On the one hand, there were hundreds of references to the correlates of survival-related apprehensions. On the other, formulations of such anxieties tended to be relatively undeveloped, and accorded little conceptual status in standard current mainstream theoretical works. Recent compendia of psychoanalytic theory and practice (Goldberger, 1996; Gray, 1994; Moore & Fine, 1995; Nersessian & Kopff, 1996; Person, Cooper & Gabbard, 2005) rarely mention these phenomena, or refer to them only in passing. I concluded that an important set of anxiety contents and experiences were either being overlooked or remained undeveloped in serious mainstream theorizing. Although these compendia did deal with psychic trauma, a closely related concept, they neither related psychic trauma to the psychoanalytic theory of anxiety nor reached any kind of consensus regarding its definition. Exceptions include the work of Krystal (1968, 1988) on Massive Psychic Trauma and volumes edited by Furst (1967), and Rothstein (1986), among others. A recent statement by Andre Green (2006) is congruent with my observation that there has been a failure to develop the implications of annihilation anxieties. Green wrote that issues such as fears of annihilation, primitive agonies and nameless dread are mentioned “in relation to theory with regard to a hypothetical appearance during the childhood of patients, but their clinical description in the adult has been given little detailed attention in clinical psychoanalysis” (p. 42, italics added).

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