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10 On some positive aspects of the negative therapeutic reaction

Limentani, Adam Karnac Books ePub

Restoration of health is only the incubation of another malady.

T.S. ELIOT, The Family Reunion

IN THIS PAPER I wish to explore those aspects of the negative therapeutic reaction (NTR) which can be of value in revealing deep-seated fears about the meaning of health for certain patients. Quite apart from being indicative that something is seriously amiss in the analytic situation, the syndrome is complex clinically and conceptually. That it does occur is not open to doubt, although in recent years there has been a tendency to dismiss it as an irrelevant usage of a term to describe a course of psychoanalytic treatment which has failed. Analysts’ opinions have been divided in attributing the failure to a special psychopathology in the patient or to faulty technique. Its confusion with various resistances is only too apparent in some case reports, just as it is clear that the term is applied even when therapy has not actually occurred. When the condition tends to be repetitive, it is possible to predict that a NTR will follow a piece of reconstruction or attempted integration, but in most cases it will occur when we least expect it, to coincide with the healing of a split or in the course of psychosyn-thesis. Freud (1919) insisted that synthesis is achieved in psychoanalytic treatment without any intervention, automatically and inevitably. He also suggested that ‘Whenever we succeed in analysing a symptom into its elements, in freeing an instinctual impulse from one nexus, it does not remain in isolation, but immediately enters into a new one’ (p. 161). As the psychosynthesis is not a wholly silent process it is understandable that there will be some acknowledgement of progress, or indeed of improvement, on the part of the patient or the analyst. The response will vary from patient to patient.

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6 Object choice and bisexuality

Limentani, Adam Karnac Books ePub

INTRODUCTION

PSYCHOANALYSIS HAS THROWN much light on the factors which enable some people to retain their homosexuality in a latent state, while others can successfully satisfy the needs of the male and female parts of their personality without being compelled to act out their id experiences in a fully fledged perversion. The capacity of certain individuals to engage in sexual activities with members of both sexes continues to present a challenge to our theoretical understanding of human sexuality and of the perversion as such. In general, theoretical and clinical discussions tend to concentrate our attention on the homosexual aspect of the dichotomy, neglecting Freud’s reminder that even heterosexuality requires justification (Freud, 1905a, p. 146).

In this context defence is understood to be directed not only at protecting the ego against anxiety aroused by instinctual drives, the superego, or external dangers, but also and preferably at including all the techniques used by the ego to dominate control and channel forces which might lead to neurosis or psychosis. In those bisexual cases where homosexuality is predominant, the heterosexuality may well assume a defensive role, which does not become apparent until one outlet is suddenly unavailable.

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16 Variations on some Freudian themes

Limentani, Adam Karnac Books ePub

AS WE HAVE REACHED the end of a long week in the course of which most of you have been working very hard, I felt that in this address I should offer you something of a diversion. All I propose to do is to share some thoughts that have occurred to me during the last few years on all kinds of subjects that matter a great deal to all of us. I may have already published some of them in one form or another, but the majority of them are casual reflections or old annotations hurriedly scribbled on a scrap of paper in response to contributions from colleagues and patients. What I have to offer could well be regarded as somewhat iconoclastic but wisdom does not come with age, as Bernard Shaw once said. Only experience increases as we get old and that can be oppressive or liberating.

As we approach the end of the century, psychoanalysis appears to become even more difficult than we ever suspected. Some of the changes that have been introduced have certainly not been easy to accept. Yet whenever a more audacious view, possibly a challenge to classical analysis, is put forward, it is de rigueur to quote Freud, no matter how often he had already contradicted or altered that view himself. The haunting thought for most psychoanalysts is: What would Freud have said about this or that?

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4 The assessment of analysability : a major hazard in selection for psychoanalysis

Limentani, Adam Karnac Books ePub

THIS PAPER is based on observations derived from my work as an evaluator of applicants for psychoanalytic training and as a consultant with the responsibility of selecting patients for psychoanalysis to be treated either privately or by students in training. Selection under such different conditions and for such a variety of purposes is made more difficult by the lack of well-defined criteria of indications and contra-indications for psychoanalysis. In the course of a week’s work a psychoanalytical consultant may be called upon to evaluate the chances of breakdown, severe enough to require hospitalization, in a patient who has been recommended for psychoanalysis. Such event, if foreseeable, is no bar in the case of private treatment, but it would certainly be a contra-indication for a supervised analysis, although the reasons for depriving a student of the opportunity to gain experience in a special aspect of his future work are not altogether clear. More understandably in the case of an applicant for training the expectation of a psychotic breakdown inevitably leads to rejection. In these examples, rationalization plays a part in decision-making. But the situation becomes rather confusing when we consider specific symptoms such as the sexual perversions. Although most psychoanalysts do not hesitate to undertake their treatment in their private practices, sexual perversions are generally regarded as being unsuitable for supervised analyses, whilst they are the basis for automatic disqualification in the case of applicants for training in some countries at least. This wide range of outlook in relation to a symptom or the possible course of an analysis can only be accounted for by the variability of our assessing capacity and predicting ability, together with the possible over- or under-estimation of analytical skills. This is a puzzling state of affairs, considering that we are dealing with a systematic form of psychotherapy, which has stood the test of time in spite of its limitations and the numerous attempts to modify and distort it by its admirers and imitators, to say nothing of the sustained attacks of its denigrators,

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9 The significance of transsexualism in relation to some basic psychoanalytic concepts

Limentani, Adam Karnac Books ePub

I INTRODUCTION

TRANSSEXUALISM HAS HITHERTO been largely ignored by psychoanalysts as being a defence against homosexuality or a bizarre and rare disorder of gender identity. In recent years a serious problem has arisen as a result of the publicity afforded to sex change operations and the unwelcome glamorization of such operations. The accumulation of clinical reports and information has not been accompanied by a substantial advancement in our theoretical understanding of the condition. When theory fails to develop at the same pace as clinical practice there will inevitably be adverse repercussions often leading to dangerous generalization and reflecting on the handling of, and approach to, each individual case.

The aim of this paper is to deal with those aspects of transsexualism which seem to challenge basic psychoanalytic concepts, and in particular castration anxiety, the oedipal complex and the role of conflict especially in relation to gender identity formation.

A further purpose is to stimulate amongst psychoanalysts the formation and expression of the psychoanalytic point of view. One recalls the time when prefrontal leucotomy was being hailed as a great advancement in the treatment of the mentally ill, neurotic and psychotic alike. This treatment is seldom used now and if lessons from the past are to be of value then a repetition of the indifference and laissez-faire attitude which was prevalent in the profession at that time should be avoided.

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