16 Slices
Medium 9781855751453

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,

See All Chapters
Medium 9781855751453

3 A re-evaluation of acting out in relation to working through

Limentani, Adam Karnac Books ePub

IT SEEMS LOGICAL that any discussion on acting out, in order to be meaningful, would have to be related to the concept of ‘working through’. There are few aspects of our daily analytical work which are more challenging than acting out and more directly pointing to the necessity and arduousness of working through the patient’s resistances, as Freud (1914) has warned us. The problem is not only that the tendency to act out needs constant attention by the analyst but also that disturbing episodes of acting out may well occur in the course of working through anxieties and conflicts under apparently quite satisfactory circumstances. I am referring to those optimal conditions where analyst and patient work well together and, of course, where the analyst has in no way contributed to force the patient to act out as a result of his own incompetence or because of the persistence of unresolved conflicts in himself. However, it would be fair to say that there are many instances when the analyst may unwittingly play a part. The experienced analyst is not only disappointed at seeing years of insightful working through wasted but may even come to the conclusion that the patient’s resistances are intractable to the point of abandoning analysis.

See All Chapters
Medium 9781855751453

8 Affects and the psychoanalytic situation

Limentani, Adam Karnac Books ePub

I

IN ANNOUNCING the main topic for the 30th Congress of the International Psychoanalytical Association in 1977, the Programme Committee noted that the problem concerning affects seemed appropriate as a focus for the discussions, since no two theories agree on it. The truth of this statement is affirmed by the most casual reappraisal of the literature as stated in a number of outstanding contributions such as those of Brierley (1951), Rapaport (1953), Rangell (1967) and André Green (1973a). The discrepancy of approach to the problem in various parts of the world is due not entirely to parochialism on the part of some writers, but rather because of the disparities between theory, technique and clinical practice. The major areas of theoretical research are: (1) the drive discharge theory, (2) the debate on the existence of unconscious affects, (3) the relationship to their mental representations and fantasies, (4) the issue concerning the possibility of affects dissociated from the object, (5) the ego as the only seat of anxiety,(6) the problem of narcissistic and schizoid personality disturbances, and (7) the widespread calls for adjustments and modifications of the classical method in the treatment of borderline and narcissistic states, which has generated further complications in the matching of theory with practice. In this paper I shall not concentrate on any one aspect of the theory of the affects or of a specific clinical phenomenon, nor will I attempt to supply any answers. I shall, however, underline certain diagnostic features which are fundamental to an understanding of the state of malaise existing in the relationship between theory and our clinical daily work.

See All Chapters
Medium 9781855751453

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?

See All Chapters
Medium 9781855751453

2 The Orpheus myth as reflected in problems of ambivalence and reparation in the oedipal situation

Limentani, Adam Karnac Books ePub

I ORPHEUS OBSERVED

MANY YEARS AGO I had a patient who was identified with Orpheus. The identification with the Poet-Hero of classical antiquity came to light suddenly and unexpectedly at the end of the fourth year of a psychoanalysis which my patient, whom I shall call Mr A, had requested on account of deep depression, inability to use his intellectual resources and a tendency to find himself rejected by men and women.

Mr A believed, with some justification, that all his problems were due to the fact that, owing to the war, he had been separated from his parents for long periods from the age of two and a half onwards. His state of mind during those early years could be reconstructed in the analysis when, during the first three years, Mr A would often phone the analyst late at night, ‘just to hear [his] voice’. In due course this was understood as an attempt to resuscitate the analyst who was felt as having died during the unbearable twenty-three hours’ separation. The only improvement at the time of the session I wish to report was shown by the abandonment of a search for a homosexual solution to his problems and the development of a well defined heterosexual disposition. Just as he was beginning to feel more secure in his dealings with women, Mr A suffered one more rejection as a result of his unwillingness to commit himself. The young woman with whom he had been in love for some time had finally married someone else. Mr A came to his session after attending the wedding ceremony, looking depressed but unusually willing to talk about his feelings, claiming that this time he had really lost everything. Admitting that he felt extremely jealous of the newly wedded couple, he insisted he was fully justified in feeling sadistic and murderous.

See All Chapters

See All Slices