The Analyst's Authenticity: “If You See Something,Say Something”

The history of authenticity in psychoanalysis is as old as analysis itself, but the analyst's authenticity in particular has become an increasingly important area of focus in recent decades. This article traces the development of conceptions of analytic authenticity and proposes that the analyst's spontaneous verbalization of his or her unformulated experience in session can be a potent force in the course of an analysis. We acknowledge that although analytic authenticity can be a challenging ideal for the analyst to strive for, it contains the power to transform the experience of the patient and the analyst, as well as the meaning of their work together. Whether it comes in the form of an insight‐oriented comment or a simple acknowledgment of things as they seem to be, a therapist's willingness to speak aloud something that has lost its language is a powerful clinical phenomenon that transcends theoretical orientation and modality.     

FROZEN HARMONIES: PETRIFIED PLACES IN THE ANALYTIC FIELD

In this paper I suggest that here-and-now transference interpretations can be defensive when they keep the focus on the intrapsychic world of the analysand and neglect the unconscious of the analyst and the unconscious-to-unconscious interaction between patient and analyst. Whilst the concept of the analytic field in psychoanalytic literature provides us with a way back to Freud's original consideration of the intersubjective alongside the intrapsychic, this inclusivity has been sustained within the Developmental School of Jungian Analytic thought. To illustrate this I present an adaptation of Jung's model of the transference. Once we engage in analytic work with an individual we are inevitably drawn into a 'dance' together with its own particular rhythms and harmonies. Each analytic couple creates an analytic field from their idiosyncratic energy flow. Within this field, interruptions to the 'dance' occur; mis-steps and disharmonies involve an unconscious refusal within the analyst as well as the patient. Both the dance and the refusal are crucial for the work, and I suggest that our attention needs to be directed here, to the blocks or 'petrified places'. To illustrate how I believe they can be made use of, I provide material from three case examples.     

Speaking Through Action,Acting Through Speech: Acting and Enacting in the Analytic Process

In this paper the author looks at the significance of different forms of action in the psychoanalytic situation. He traces the development of related concepts, going back to Freud's early concept of a ‘symptomatic act’ and the introduction of his concept of ‘acting out’ with the Dora case, through to more modern and complex ideas of enactment. He shows that acting out can have a defensive as well as a communicative function. Actions can be a way of ‘speaking’ to the analyst, of communicating things that cannot be thought or put into words. On the other hand, speech itself can become an action rather than a form of symbolic communication, a way of putting pressure on the analyst to fit in with a projective phantasy. Important theoretical contributions to the concept of enactment, by Sandler, Joseph, Feldman and Tuckett, are described in some detail. Looking at Freud's Dora from such a perspective, the author argues that an enactment developed between Freud and his patient. Detailed clinical material is presented to show how the author uses these concepts in his own analytic work. Finally, the relationship between enactment and containment is discussed.     

ON THE SLOPES OF BROKEBACK MOUNTAIN: COUNTERTRANSFERENCE IMPEDIMENTS TO AN ANALYTIC ATTITUDE IN WORK WITH GAY MEN

abstract    There have been many debates about psychoanalytic and Jungian views of homosexuality. As part of these it has often been recognized that analysts have appeared reluctant to comment on their own countertransference responses to gay patients. Yet these responses must inevitably have a significant bearing on the way the work is conceptualized and undertaken. This paper highlights ways in which homophobia and related countertransference difficulties influenced the author's ability to engage with one male patient. It traces the process by which the analyst became aware of his own discomfort and the nature of his struggle to find a more helpful and reflective position in the analytic work. The process was prompted by a dream which depicted some of the difficulties the analytic pair was experiencing and by a heightened scrutiny of the countertransference. The progress of the work is marked by three further dreams which trace the development of the analytic relationship.     

The Piggle: Decoding an Enigma

The Piggle, in its 40th anniversary year, was published after Winnicott's death. He treated this 2‐year 4‐month‐old girl over two and a half years. Yet, until recently, The Piggle has been ambivalently reviewed and minimally studied, despite elegant posthumous papers, a recent introduction to Winnicott's collected works and an interview with the ‘Piggle’ in adulthood. We show that Winnicott's technique and interpretations fall into three categories: (1) early Kleinian ‘deep’ interpretations; (2) an Anna Freudian approach with developmental considerations, respect for defences, the analyst as a new developmental object; (3) a Winnicottian attitude and interpretations that hew close to the manifest material and emphasize the environment–individual relationship and full‐bodied play. Winnicott's ‘interpretations’ include verbal interpretation, prosody, gesture, facial expression, body movements and contact. Winnicott details the child's reactions to the different interpretations. We close suggesting that Winnicott carried on dialogues, not only with the child, but also internal dialogues with former teachers (Klein/Riviere; Strachey as his first analyst and so connecting to the Freudians in the Institute of Psychoanalysis) and perhaps with Anna Freud as a colleague after her arrival in London in 1938. This is a manifestation of false versus true (analytic) selves. Understanding Winnicott's internal struggle with his former teachers/analysts, corrected by his responsiveness to the child's responses and suggestions, resulted in his bringing a truer self to this child's treatment and unravels The Piggle's enigmatic qualities.     

On Lacan and Supervision: A Matter of Super‐Audition

Supervision is crucial to most forms of talking therapy. This article focuses on psychoanalysis and explores how supervision can be conceptualized from a Lacanian point of view. We discuss two principal ideas about supervision from Lacan's work: making the analyst sensitive to the symbolic component of the unconscious and becoming sensitive to the interrelation between language and jouissance. These ideas comprise two stages that Lacan discerned in the process of supervision: the ‘stage of the rhino’ and the ‘stage of the pun’. We illustrate Lacan's distinction between these stages by means of vignettes of analysts who were supervised by Lacan. We argue that an additional third stage should be discerned, concerning the challenge of incarnating the position of the so‐called object a. Last, we discuss the pitfalls that an analyst might experience when conducting and directing the analytic work, namely the consistency of the imaginary, the delusion of the symbolic and the real of the body.     

An Outline of Our Contemporary Freudian Approach

In this paper the authors give a summary of their Contemporary Freudian approach to clinical work. The main theoretical perspectives are described followed by the clinical principles guiding clinical work with adults. A clinical example is then given to illustrate how these principles inform the analyst's listening and formulation of interpretations. Our Contemporary Freudian approach has developed over many years of clinical work and study and our immersion in the life of the British Psychoanalytic Society with its different schools of thought. It is based on the Freudian tradition: the conceptualization of the dynamic unconscious and the role of unconscious phantasy which informs our understanding of the unfolding analytic process. The Freudian developmental perspective (further elaborated by Anna Freud and others) is the essential basis on which we understand the patient's history and current mental functioning. The centrality of the body with its sexual and aggressive drives that have to be integrated into the individual's self and object representations over the course of development, remains fundamental in our clinical approach.     

LISTENING TO SILENCE

ABSTRACT I have examined the function of silence - its possible role and meanings - in the psychoanalytic encounter. I have argued that silence is complementary to words in general, and to analytic free associations in particular, and that silence in the patient is often more than just the expression of his resistance. It could be useful to consider the silent space within a session as a sort of container of words - words that for complex, overdetermined, unconscious reasons cannot be uttered. I have insisted on the significance of analytic silences and warned against responding to them either through a retaliatory silence or through a flood of premature interpretations. These inadequate reactions often stem from the analyst's own anxiety evoked in him by the patient's silence. Anxiety and silence are closely connected. Each silence is a compromise formation, concealing the unconscious fantasy from which it originates, while expressing a conscious one, often related to the transference situation. It is the task of the analyst to listen to his patient's silences in order to help him understand their meanings.     

Listening to Silence

SUMMARY. I have examined the function of silence - its possible role and meanings - in the psychoanalytic encounter. I have argued that silence is complementary to words in general, and to analytic free-associations in particular, and that silence in the patient is often more than just the expression of his resistance.
It could be useful to consider the silent space within a session as a sort of container of words -words that, for complex, over-determined, unconscious reasons cannot be uttered. I have insisted on the significance of analytic silences and warned against responding to them either through a retaliatory silence or through a flood of premature interpretations. These inadequate reactions often stem from the analyst's own anxiety evoked in him by the patient's silence.
Anxiety and silence are closely connected. Each silence is a compromise formation, concealing the unconscious fantasy from which it originates, while expressing a conscious one, often related to the transference situation. It is the task of the analyst to listen to his patient's silences in order to help him understand their meanings.     

Complementary individual and group analytic training for future psychotherapists

Whereas individual training analysis offers the candidate the possibility of thoroughly working through unconscious tendencies, desires, and anxieties that come to the foreground, a dyadic setting group analysis permits one to observe and to analyze all the many narcissistic, power, and rivalry problems that are activated in a group setting, and to undergo a social learning process. The author describes the value of training for the (later) activity as individual or especially as group analyst. This training includes participation in an analytic self-experience group (psychodynamic group process), supervision by an experienced group analyst of the work done in an analytic group, and comoderating of an analytic group by two psychotherapists.     

The Explanation of Impulsive Action

Impulsive action, such as binge eating or drinking, wrist-slashing, compulsive promiscuity or chronically explosive marital conflict, presents serious problems for psychoanalysis. Such action evokes explanations both from the analyst and from the patient. The analyst may be held captive by explanatory notions that emphasise one aspect of impulsive action rather than the whole process. These explanations are based on our notions of drive pressure, adaptation, control and attack of intimate persons, ‘acting out,’ and the ‘compulsion to repeat’. The patient's explanations may be either consciously stated or inferred by the analyst as unconscious‘explanations’from associative material. If the patient's explanations dovetail with or adapt to those of the analyst, the analyst may take them as confirmatory, and the whole process of breakdown and restitution may escape analytic scrutiny. This process includes: (1) a precipitant that is narcissistically wounding; (2) a prodrome consisting of an experience of lack or absence which the patient feels as persecution, and a restitutive phantasy of the lack as fillable by a consummatory act; (3) the act itself; (4) character defences that ward off mortification on awareness of personal disintegration (shame) or the consequences of the act (guilt); explanations emphasising guilt often screen those giving rise to shame; (5) an attempt to regulate distance to protect against narcissistic injury by keeping intimates from getting too close or too far away. The therapist's tendencies to overemphasise the precipitant, the meaning of the act, or its distance regulating may convey an attitude of blame rather than understanding. Therapeutic emphasis on the subjective experience in an unintegrated way is sympathy, not empathy; sympathy is collusive and fosters splitting and impedes working with the negative transference. Blame or sympathy may be buttressed by the type of explanation accepted by analyst and patient. Explanatory preconceptions must be transcended to do effective interpretive work. Interpretation should convey understanding of a preoccupied ego that manifests its disorganising and restitutive propensities in the process of impulsive action.     

Healing, Exorcism and Object Relations Theory

From the earliest years of the psychoanalytic movement analysts have inclined to be either healers or exorcists. Jung, Ferençzi, Rank and Reich seem to speak with the characteristic voice of the healer. There is an implicit trust in the healing power of relationship, an emphasis on the patient's creative potential, a readiness to engage. Whereas those analysts, like Karl Abraham, who followed Freud's advocacy of analytic detachment, maintain a greater distance between themselves and their patient while focussing on the negative aspects of the infantile psyche. This tradition set the style of the classical analytic approach rigorously maintained by Melanie Klein and her followers. The Kleinian school actively challenges resistance, manipulation, seduction and all the carefully hidden expressions of negative transference. In their determination to‘name the devils’and their readiness to confront them, they, like Davanloo, take the characteristic stance of the exorcist. While healing and exorcism are very different modes of functioning, it would be a false simplification to see them as mutually exclusive. The shaman, in reclaiming the lost soul, must at the same time do battle with the devils that hold it captive. The exorcist, even as he drives out the demons, prays earnestly for the soul of the sinner. An object relations analyst must be capable of controntation when the occasion warrants; equally the classical analyst heals through sensitive understanding and the maintenance of safe analytic boundaries. Healing alone will fail where no attempt is made to purge the patient of his bad inner objects. But, more fundamentally, the whole therapeutic enterprise is meaningful only to the degree that a truly human connection has been established. The difficulty is to move freely between the two modes and to see them as complementary aspects of a single process.     

The Facilitating Function of the Setting

This paper addresses the issue of what facilitates creativity in psychoanalytic work. Although creativity may seem to imply a creatively interpreting analyst/therapist, dictionary usage of the term ‘creativity’ supports an alternative reading. The author finds a more apt standpoint in the theory of the analytic site that Donnet has extrapolated from Freud's papers on technique. From this viewpoint, creativity in psychoanalysis is the autonomous or spontaneously flowing analytic process, and the factor that facilitates it is the carefully constructed and maintained setting, or site, and the patient's transformational introjection of it. A comparable standpoint applies to creativity in psychotherapy and psychodynamic social work. Provided that the setting/site proper to that treatment modality is adequately constructed and maintained, the psychoanalytical psychotherapy site and the even more radically different psychodynamic social work site can both be comparably introjected, resulting in each case in a spontaneously flowing or autonomous therapeutic process that is analogous to the analytic process. The author discusses the uniqueness of each ‘site’, and illustrates, from a once weekly psychotherapy, the patient's gradual, created/found encounter with elements of the psychoanalytical psychotherapy site and cumulative introjection of them to a critical point of metamorphosis that ushered in an autonomous therapeutic process.     

In the Name-of-the-Father: Absent Presence

Psychoanalysis exists! It exists despite splitting attacks made on it by the analysand, and by the analyst's own internal objects, which threaten to destroy it. But it is the silent abundant goodness of the analytic setting, its freedom, its openness, its 'without memory or desire', that enable us to experience primary hate in face of terror. But no one possesses this goodness. Unless the analyst has some acknowledged or unacknowledged faith in this goodness, which is never his own, he will not be able to bear envy and will resort to cynicism or manipulation.     

A Jungian Approach to Analytic Work in the Twenty‐First Century

In Part 1 of this paper the authors summarize those key concepts in Jungian analytic theory which differentiate it from a psychoanalytic approach. To illustrate these perspectives and their application in clinical work, a patient is introduced. The authors elaborate on a particular dream with the proposition that it holds within it both an image of the internal world of the patient's personal psyche and something which might be viewed as archetypal and emerging from the collective unconscious. Part 2 focuses on more recent developments in Jungian analytic thinking. Michael Fordham's important work in extending Jungian theory into an understanding of infant development is summarized and illustrated by a clinical example. This is followed by a brief summary of how contemporary debate within the Jungian analytic community has been much affected by recent developments in areas outside the analytic discourse which have offered both a challenge to and an affirmation of certain Jungian concepts. Examples given are from emergence theory and neuroscience. The Jungian interest in such phenomena stems from a view of the human psyche as rooted in a wider world of matter, culture, history and an unconscious that is not only personal but also collective.     

Fundamental Considerations in the Psychotherapy of an Identical Twin

Identical twins encounter unique psychological and maturational difficulties alien to the experiences of single children. A brief review of the literature on these points is presented, emphasising both the tormenting and gratifying aspects of a twin who has in the outside world another identical self that the world notices and confuses with him. Such aspects need to be taken into consideration when engaging an identical twin in analytical psychotherapy. 'Fallout' from psychotherapy can have repercussions on those close to the patient but in the case of identical twins the effects on the twin not in therapy can be disastrous. In particular, when psychotherapy-by-proxy ensues it appears possible for the co-twin to establish strong links to the analyst through his narcissistic relationship with his twin, which appear transferential in nature. A clinical vignette is presented which elaborates on the issues of twin transference and the fallout effects on the twin not in therapy. A question is put forward: whether it is realistic to analyse identical twins individually and not together when their narcissistic dependency and defensive hostility are paramount to internal processes. The author takes the view that a psychoanalytical orientation to the psychotherapy of an identical twin is the most recommended but cautions against individual psychoanalytical psychotherapy where the real drive is the assassination of the internal and external twin-object as a means to individuation from the twinship. The nature of this object - whether selfobject or transformational object - is tentatively discussed.     

The Independent Tradition

The authors have preserved the format of their original presentation where Anne Tyndale described the conceptualizations that characterize the Independent approach: namely, their reliance on the living experience offered by the analytic frame illuminated by timely interpretation. Interpretation emerges from the experience of listening – to the analysand and to the analyst's own psychic movements. In this context, premature interpretations of the transference are purposely avoided, as they risk creating a superimposed and artificial dynamic between analysand and analyst. Viqui Rosenberg illustrates the approach and offers her reflections.     

Yawning: unsuspected avenue for a better understanding of arousal and interoception

Almost all the vertebrates yawn, testifying the phylogenetic old origins of this behavior. Correlatively speaking, yawning shows an ontogenical precociousness since it occurs as early as 12 weeks after conception and remains relatively unchanged throughout life. Thus, it is contended that these common characteristics and their diencephalic origin allow to model an approach from which emerges a pivotal link between yawning and REM sleep. Yawning and stretching reverse the muscular atonia of the REM-sleep and reopen the collapsed airways. Yawning appears as a powerful muscular stretch, recruiting specific control systems particularly the paraventricular nucleus of the hypothalamus, the locus coeruleus and the reticular activating system from which the vigor of this ancestral vestige, surviving throughout evolution with little variation, may increase arousal. On the other hand, the James-Lange theory proposes that afferent feedback from muscles and viscera provides the brain with a feeling that characterizes the active motivational state and arousal. On this basis and using selected supporting findings from the literature and from data provided by daily life, it is contended that yawning takes part in interoceptiveness by its capacity to increase arousal and self-awareness. Adaptative behaviors depend on interactions among the nervous system and the body by a continuous feedback between them. The body's schema is a main component of the self, and interoceptive process is essential to awareness of the body and arousal. Yawning contributes to bodily consciousness as a behavior affiliating a sensory motor act and his perception from which pleasure is derived. Yawning can be seen as a proprioceptive performance awareness which inwardly provides a pre-reflective sense of one's body and a reappraisal of the body schema. The behavioral consequences of adopting specific regulatory strategies and the neural systems involved act upon attention and cognitive changes.Thus, it is proposed that yawning is a part of interoceptiveness by its capacity to increase arousal and self-awareness.     

The Internal Cohabitation Model

This paper presents the reasons for viewing the conflicts of inner mental life as arising from the problematic interaction of two different selves. A self that is involved in interpersonal relationships can be seen to be contending with a coexisting self who has a hatred of dependency on others. When the self that idealises independence is dominating the inner world, any means will be used to achieve the desired ends, regardless of the consequences for anyone. The paper makes links with the work of neuropsychiatrists such as McGilchrist and to the contributions of Bion, Britton, Winnicott and other analysts who have recognized the existence of different selves in the inner world. An analytic session is presented to illustrate the process of mapping out of ‘who is doing what to whom’ in the clinical interaction. We argue that transference misattributions can be better understood by recognizing the differences between the two selves internally. This detailed differentiation can then assist the patient to reduce the likelihood of internal takeovers both in the analytic setting and in other relationships.     

A self‐caricature of michelangelo buonarroti hidden in the portrait of vittoria colonna

The specialized literature has described how the great anatomist par excellence, Michelangelo Buonarroti (1475–1564), like many other renowned artists of his time, included a self‐portrait in many of his works. This article presents novel evidence that Michelangelo inserted his self‐portrait into a sketch of his close friend, Vittoria Colonna (1490–1547). This work, made by Michelangelo in 1525, is currently in the collection of the British Museum in London, England. This self‐portrait of Michelangelo can serve as a tool for analyzing the artist's probable bodily dimensions and even his state of health during this period of his life. Clin. Anat. 31:335–338, 2018. © 2018 Wiley Periodicals, Inc.