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CHAPTER SEVEN: Meet Mohamed and the method implemented

Freedman, Norbert; Geller, Jesse D.; Hoffenberg, Joan; Hurvich, Marvin; Ward, Rhonda Karnac Books ePub

Marvin Hurvich and Norbert Freedman

The recorded psychoanalytic therapy of Mohamed, a refugee from torture in Somalia, treated in Oslo, Norway is the subject matter of this chapter. We begin with a brief portrait of Mohamed, sketch out our method of analysis of the transcripts of sessions,2 present an account of the major variables of concern, Annihilation Anxiety (AA), and the symbolizing process (Symbolization and Desymbolization), and then return to the theme of our Propo-sitional Method with the question: how to infer clinical change or a process of transformation?

Mohamed was a political refugee from an African country. He was in his early forties and was an active Muslim. He had a wife and six children at the time of his arrest in the mid-Eighties for his association with groups opposing the dictator of his country. He was in prison for nine years, where he experienced severe torture, maltreatment, and under-nourishment, and was also sentenced to death. He was forced to watch the torture of his wife and one of his daughters, as well as to witness torture and other inhumane acts being inflicted on fellow prisoners, including children. A recurrent theme in therapy was his agony about what he had seen the soldiers and prison guards doing to others. This tormented him as did the physical suffering he himself had experienced. He managed, in spite of this, to find some comfort in his religious beliefs all through his time in prison. However, it was a hard blow for him when the authorities circulated a rumour that he had betrayed his comrades during torture.

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COMMENTARY: Three pathways towards the modification of Annihilation Anxiety

Freedman, Norbert; Geller, Jesse D.; Hoffenberg, Joan; Hurvich, Marvin; Ward, Rhonda Karnac Books ePub

Marvin Hurvich and Norbert Freedman

In the course of the preceding chapters and the three successive pathways of modification we have encountered several issues concerning the structure of the annihilatory process and its relation to Symbolization, which are not specific to each chapter but have a general relevance to our entire enterprise. Here are some of the salient issues.

That the meaning of a psychoanalytic concept and its clinical implications vary with the clinical or social context in which it appears has been a tenet of the Propositional Method (Chapter Six). The very title of this essay, “Three Pathways towards the Modification of Annihilation Anxiety”, implies three clinical contexts: pathway 1—early transference engagement; pathway 2—clinical regression one and a half years later; and pathway 3—revisiting a traumatic episode after ten years of psychoanalytic work. In all three situations Annihilation Anxiety, its prevalence and intensity, was essentially high; it was a relative constant. Annihilation Anxiety indeed is a constant confrontation with dangers to psychic survival. What changes vastly are its modifiers.

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CHAPTER EIGHTEEN: Nodal moments and the essence of Progressive Symbolization

Freedman, Norbert; Geller, Jesse D.; Hoffenberg, Joan; Hurvich, Marvin; Ward, Rhonda Karnac Books ePub

Norbert Freedman and Rhonda Ward

The question is: “What have we learned about working through?” For some authors, this concept, given to us by Freud in 1914, is too vague, too all-encompassing, refers simply to a higher level of compromise formation, and hence should be discarded. Notwithstanding this pessimistic assessment, we undertook a specimen study, using the Propositional Method to illuminate the specific components of working through. We examined a transformation cycle, delineated its four phases, and distilled the specifics of each.

To review, within every phase we noted a paradoxical move: the initial symbolizing phase was marked by the appearance of induced transference regression and with it the onset of the downward slope (Chapter Fourteen); the desymbolizing phase, one of unambiguous regression, contained at critical junctures nodal moments, signs of reversal and signifiers of the upward slope (Chapter Fifteen); the enactive phase, marked by both patient and analyst centered enactments, culminated in higher symbolic forms (Chapter Sixteen); and the re-symbolizing phase, with the appearance of a frankly erotic transference, contained a mini-cycle, a recapitulation of the previous phases, leading to both higher as well as lower levels of symbolic functioning (Chapter Seventeen).

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

Freedman, Norbert; Geller, Jesse D.; Hoffenberg, Joan; Hurvich, Marvin; Ward, Rhonda 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 TEN: Transformations in long-term psychoanalytic psychotherapy: the case of Ms K

Freedman, Norbert; Geller, Jesse D.; Hoffenberg, Joan; Hurvich, Marvin; Ward, Rhonda 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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