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CHAPTER FIFTEEN: The emergence of nodal moments during the desymbolizing phase: sessions 245 to 249

Norbert Freedman Karnac Books ePub

Norbert Freedman and Rhonda Ward

While in church after communion, connecting within her heart to God, holding her baby on her lap and feeling love for her, Ms Y encountered a moment of a coming together of meaning, of uniting disparate parts within herself, be they a linking of hallucinatory wishes to reality, subjective self-awareness with objective self-awareness, or the splits arising from triangular conflict. This scene from the end of session 243 (Chapter Fourteen) was a nodal moment preceded by a transference regression. It was a moment of unification, marked by a surge of libido, a crucial ingredient of ego synthesis. When such a nodal moment occurs during a regression, it is a first step in the direction of the upward slope and of Progressive Symbolization.

Nodal moments highlight paradoxical transformations at work. These crucial events are preceded by episodes of desymbolization, where the underlying meaning is implicit and unformulated. But when the nodal moment appears, meaning becomes explicit, formulated, symbolized. It is in the transformation from the unformulated to the formulated that the paradox can be discovered, processed, and confronted.

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CHAPTER ONE: The effectiveness of psychoanalytic psychotherapy: the role of treatment, duration, frequency of sessions, and the therapeutic relationship

Norbert Freedman Karnac Books ePub

Norbert Freedman, Joan Hoffenberg, Neal Vorus, and Allan Frosch

The above title of the 1999 study names the implicit ingredients of both psychoanalysis and psychoanalytic research. With effectiveness, we emphasize the need for the treatment to be registered in the consciousness of the patient. With duration, we note that the consequence of psychoanalytic treatment is cumulative, leaving its imprint over time. With frequency of sessions, we underscore the idea of therapeutic intensity. And, with treatment relationship, we affirm that the therapeutic effort is an intrinsically dialogic undertaking. In our 1999 study we sought to capture the common ground in our psychoanalytic community, if not the essence of the psychoanalytic enterprise. Just as we can speak of a foundational transference (Frankel, in press), with this study we develop a foun-dational psychoanalytic research undertaking.

In a recent review article based on a comprehensive meta-analysis of a wide range of studies, Shedler (2009) finds significant efficacy and effectiveness with psychodynamic treatment. Two findings stand out: (a) “effect sizes for psychodynamic therapy are as large as those reported for other therapies” designated as “evidence-based” (p. 98); and (b) “patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends” (p. 98). In his definition of dynamic therapy, Shedler cites procedures which focus on the consciousness of the patient, such as raising affect awareness, emphasis on the therapeutic relationship, and concern with a patient's history, all of which are part of the psychoanalytic perspective.

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CHAPTER THIRTEEN: Method and findings: the case of Ms Y: the patient and her analyst within the context of a recorded psychoanalysis

Norbert Freedman Karnac Books ePub

Norbert Freedman, Richard Lasky, and Rhonda Ward

At the time of this research, Ms Y was a professional woman in her thirties, and a mother of a three-year-old boy and a newly adopted infant daughter. She and her husband were residing in a suburban community in the US Midwest, enjoying a secure income. About six years prior to this study, she began a twice weekly psychotherapy and in her second year of treatment converted to a four-times-a-week psychoanalysis.

According to the analyst, the tone of the treatment shifted dramatically during the first two years of the analysis. The initial transference, one of non-engagement and affective withdrawal, developed into a sadomasochistic transference and then into one that was explicitly erotic. This intensity, one of over-engagement, seemed to have been a defence against the initial schizoid-like position, though, as the treatment progressed, acute neurotic conflicts also surfaced. It was at this stage that we entered the study of the treatment process.

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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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