Friston, Free Energy, and Psychoanalytic Psychotherapy.

This paper outlines the ways in which Karl Friston's work illuminates the everyday practice of psychotherapists. These include (a) how the strategic ambiguity of the therapist's stance brings, via 'transference', clients' priors to light; (b) how the unstructured and negative capability of the therapy session reduces the salience of priors, enabling new top-down models to be forged; (c) how fostering self-reflection provides an additional step in the free energy minimization hierarchy; and (d) how Friston and Frith's 'duets for one' can be conceptualized as a relational zone in which collaborative free energy minimization takes place without sacrificing complexity.

Grace, too: the sense of agency and Jeremy Safran's relational vision.

The sense of agency, our felt sense of authorship for our actions, is a difficult concept to define, yet its faltering stands at the heart of psychopathology. Historically undertheorized by psychoanalysis and typically positioned opposite relatedness by clinical psychology, Jeremy Safran conceived of agency and relatedness as paradoxically related. This paper pays tribute to Safran's ideas by taking his writings on agency as a starting point to elaborate how agency forms, and goes awry, in the relational crucible of early life. In doing so, the paper draws on the developmental theory of Winnicott, empirical research on embodied agency from adjacent fields of study, and Safran's clinical phenomenology.

A clinical seminar on Spinoza and Bion: a conversation between Miller AND Koritar.

The present transcript follows an online discussion held on April 3, 2022, between Ian Miller, author of Clinical Spinoza: Integrating His Philosophy with Contemporary Therapeutic Practice (2022), and Endre Koritar.

Bound by Infinities: Technology, Immediacy and Our Environmental Crisis.

This paper explores the relationship between human desire, technology, and imagination, emphasizing (1) the phenomenology of this relationship, and (2) its ontological and ecological ramifications. Drawing on the work of Bion and Winnicott, the paper will develop a psychoanalytic container for attitudes contributing to our current climate-based crisis, paying special attention to the problematic effect technology has had on our sense of time and place. Many of our technologies stunt sensuous engagement, collapse psychic space, diminish our capacity to tolerate frustration, and blind us to our dependence on worlds beyond the human. In short, our technologies trouble our relationship to our bodies and other bodies. The paper argues that omnipotent fantasies organizing our relationship to technology, to each other, and to the nonhuman world, have cocooned us in a kind of virtual reality that devastates a sense of deep obligation to the environment.

'I Do Not Exist': Pathologies of Self Among Western Buddhists.

This paper presents a clinical case involving a patient suffering 'depersonalisation' who had a psychotic episode at a Buddhist retreat. Recent writing on possible psychological risks of meditation has discussed problems of depersonalisation associated with misunderstandings of the Buddhist conception of non-self (anatman) and emptiness (sunyata). Drawing on the work of Winnicott and Bion, this article helps us to realise some of what is at stake in the failure to achieve and maintain an effective sense of self. What does Buddhist talk of non-self really mean? What conditions enable a creatively engaged and meaningful relational life, a sense of aliveness, human flourishing and a capacity for alterity?

From Die Traumdeutung to The Squiggle Game: A Brief History of an Evolution.

It is often possible to retrace the history of a new concept or a new technique, identifying precursor and reflections that would lay the foundations for the birth of something "new". This also applies to the "squiggle game" of Donald W. Winnicott, one of the Winnicottian "creations" in which the distinctive signs of its fatherhood are more evident as, at the same time, are evident several debts to other scientists: from Freud's interpretation of dreams, through Jung, Klein and Fordham to Milner's "free drawings".

I Am a Mystery to Myself.

Throughout my lifetime I have had a vague sense of my identity. There were no distinct memories or stories from my childhood and adolescence to provide me with the recognition, much less an appreciation, for who I was in the world. It wasn't until I entered psychotherapy that revelations about my family life came into understanding. This was not from any recollecting of actual events but from the indirect observations of families where being engaged with each other had occurred. Through psychoanalysis, reading a variety of psychoanalytic thinkers, and by taking up my own writing I was encouraged to discover myself, even at the cost of the sorrow of never having that encouragement in growing up, the cost that comes with the exploration. Where no childhood home was to be found a new one was to be created instead.

So, Doctor, Now, What Do I Do?

This paper proposes a discussion about acting on the therapeutic relationship using the notions of playing and the "use of an object" formulated by Winnicott; the formulations of Ferenczi as the concepts of introjection and the "ability to feel with", as well as the concept of cartography from Deleuze and Guattari. It discusses how to manage the meeting with individuals who confront the analyst with sudden questions, gestures and actions. I propose that the management of the acting considers that there is a call for a conversation in which "doing" is in question, and in which the playful dimension of activities without rules is employed as a necessary option.

The Risk of the Revelatory State.

Patients enter states that in their spontaneity and deep interiority have qualities of the revelatory. I propose we recognize such a state as a clinical event: The person is in a state of intense internal receiving of self. We might think of it as a state of internal communication happening as the person speaks. The person feels real to herself. Her relation to her mind in this revelatory moment is easily intruded on-even by ventures of play. When the state is gone, it is gone. I single out this clinical moment from moments that are cocreated and happening within an analytic third. I argue that in the revelatory moment, a patient builds capacities to be present for pain, desire-for raw experiences ordinarily difficult to access. The state makes a strict demand on the analyst. I see it as a moment of object usage-that is, it is a moment of risk with the analyst. This moment challenges and deepens our understanding of Winnicott's usage formulation.

"Bound Tightly in the Pack": Cloth and Care in I Never Promised You a Rose Garden.

Talk therapy is, by definition, difficult, if not impossible, to represent materially. Whereas other scholars have sought to do so by referencing Sigmund Freud's drawings or the setting of his consulting room, this article looks instead to the use of cloth in Joanne Greenberg's 1964 semiautobiographical novel I Never Promised You a Rose Garden. The two main treatments given to protagonist Deborah Blau were therapy sessions with Dr. Clara Fried, based on Frieda Fromm-Reichmann, and the "cold pack," in which the patient was restrained and wrapped in sheets drenched with ice water. The two treatments, this article argues, can be considered in parallel, and through analysis of the material descriptions of the cold pack, one can learn more about the talking cure. Namely, this article analyzes the care in both cases as one of constraint, giving material form to the metaphorical "holding environment" of psychoanalyst D. W. Winnicott. Deborah uses the cold pack to endure her psychosis and return to reality. Similarly, Winnicott describes the ideal therapeutic space as one that, by its reliability, allows regression in service of finding a new self and distinguishing between fantasy and the outside world. The aim of this article is thus twofold: one, to further elucidate the role of cloth in treating mental distress, and two, to understand more fully the therapeutic relationship via the literal and figurative constraint of treatment.

Selected for Solitude: A Case Report of Loneliness.

The U.S. Surgeon General, Vivek Murthy, recently declared loneliness a public health epidemic. For therapists, that is not likely to be a surprise: Loneliness is so common in people who seek therapy that it might be seen as the bread and butter of our work. Despite that, there has not been much serious examination of intrapsychic factors that may contribute to this painful condition. Public discourse has focused instead on cultural and societal causes of loneliness, and on practical steps that might be taken to decrease it. But practical advice is not always sufficient for people with longstanding loneliness. Longstanding loneliness may be fueled by intrapsychic dynamics and become embedded in character. In some cases, patients may relish companionship yet steadfastly avoid it in an attempt to master early childhood experiences of being emotionally neglected and deprived of love. They were starved of love as children and now choose to starve themselves in an unconscious attempt to master early deprivation by identifying with the aggressor. For patients like this, chronic loneliness may signal a certain kind of attachment disorder, for it is the visible sign of early attachment to a distant or rejecting parental figure. Loneliness of that kind can be a stubborn problem and one that poses a considerable therapeutic challenge.

Psychoanalysis and the Experience of Homelessness.

Psychoanalysis is often viewed as a practice relevant only to educated people of means. This article describes a project that matches psychoanalytically trained clinicians with unhoused and formerly unhoused adults in a large urban community. D. W. Winnicott's ideas about impingement, the holding environment, fear of breakdown, and careful monitoring of the analyst's interiority have proven to be most valuable theoretical and clinical tools. A decade-long case example demonstrates the challenges and healing potentials of the work.

Pragmatism or idealism: a systematic review and visual analysis of Winnicott's psychoanalytical treatment views.

Winnicott is an outstanding representative of the School of Object Relations, and his unique psychoanalytic treatment views have been greatly influential to the psychoanalytical community. Winnicott emphasizes the impact of facilitating environment and the key role of the maternal-child relationship in the early psychological growth of individuals. He puts forward the ideas of the development mechanism of the true self and the false self, which builds a bridge between the characteristics of adult psychopathology and the characteristics of early maternal-child relationships, providing a new perspective for research on individual self-development and psychoanalysis. Winnicott creatively introduces the concepts of the transitional object and the transitional phenomena into the theories of Object Relations. He relates the transitional experience to the field of mental health, and extends it from the relationship between the mother and the child to adult life, which not only has had a revolutionary impact on modern psychoanalysis but also literature, aesthetics, and other fields. Winnicott highlights the importance of the patient's emotional development in the treatment. He advocates holding the patients' sentiments and meeting their emotional needs. He also approves of the emotional reparenting of the patients, to make them gain the ability to establish a relationship with the real world. His treatment views formed through a large number of clinical practices are very practical and full of humanistic care. This review summarizes Winnicott's psychoanalytical treatment views as well as his marvelous original concepts, and analyzes the hot topics of academic research on his theories based on a visualization analysis by using the software CiteSpace, which includes data in the Web of Science Core Collection published from 1978 to 2023 with 365 papers involved. The study provides a macroscopic and panoramic review of Winnicott's theories, and it clearly shows Winnicott's significant influence on the field of psychoanalysis and related fields.

Abolishing the Captivity of a Tyrannized Woman: Evidence of Bion's Concept of the Contact-Barrier as Manifested in Dreams.

Bion's notion of the contact-barrier formulates a semipermeable membrane responsible for preserving the distinction between the conscious and the unconscious. However, the question of how a newly established contact-barrier manifests itself in dreams remains unanswered. The author proposes that one such manifestation occurs when a patient sees themself asleep in a dream. A case of a severely traumatized woman who had difficulty thinking and being close to others is used to explore these clinical ideas. The author, in response to his reveries in a session, introduced a playful dream-like dialogue between a playwright and his reader. The nature of the communication, in functioning as a barrier, served to protect the patient from a tyrannizing reality: the therapist's sexuality. This intersubjective barrier helped the patient to contact dissociated and damaged parts of herself, and it also facilitated her ability to dream a sense of her own boundaries, femininity, and sexuality.

The Good-Enough Donor: Sperm as a Good, Not-Me Possession.

Reproductive endocrinologists often recommend sperm donation to two groups of patients. The first are women with partners with azoospermia. The second are women who do not have a partner and yet desire to become a parent. This article focuses on a subset of women in these two groups who hesitate to accept this recommendation from their reproductive endocrinologist. Winnicott's writings on transitional phenomena, especially his description of how the infant creates good, not-me possessions, may be helpful in our understanding of some of these women's fantasies of sperm as a bad, not-me possession. Case material is used to highlight treatment recommendations that utilize a reframing of the understanding of the donor's motivation, which may create the possibility of an acceptance of sperm as a good, not-me possession. This moves the patient toward what Winnicott calls acknowledgement of indebtedness and toward what the patient may perceive as a good-enough donor.

A Metapsychology of the Unrepresented.

The terms unrepresented and unrepresented states are increasingly being referred to in psychoanalytic discourse, without our having established a generally agreed upon consensus about their definition, use or meaning. While these particular designations were never used by Freud, a careful reading of his work reveals them to be qualities that characterize the initial state of both the drive and perception. This paper attempts to place these terms in a clinically useful, metapsychological perspective by reviewing their conceptual origin in Freud and examining their elaboration and clinical relevance in the work of Bion, Winnicott, and Green. These concepts should prove especially useful for understanding and addressing problems presented by non-neurotic patients and psychic organizations and will help expand the reach and efficacy of psychoanalytic understanding and technique to increasing numbers of contemporary patients.

Understanding of Holding Environment Through the Trajectory of Donald Woods Winnicott.

Personal life and achievements are the process and result of a person's past, present, and future interacting with each other. In this regard, if one fully understands the life and background of the person who developed the theory of psychoanalysis, one can understand and use the theory more appropriately. The holding environment theory developed by Donald Woods Winnicott is useful for understanding the process by which infants grow healthy under the care of a mother who is good enough. In this paper, the background of the birth of the holding environment theory is reviewed based on Winnicott's developmental background and marital life. He grew up with a holding environment from good enough 'multiple mothers'. Born with excellent athletic ability and musical talent, he was more curious than anyone else and particularly active in discovering new things. After the unhappy first marriage, Claire Britton's second marriage was happy academically and personally. Claire was a fellow paediatric psychoanalyst who published Winnicott's research and theories after his death. Psychoanalysis or psychotherapy itself can be a holding environment, and the holding environment theory can be applied to various fields in the digital era.

A Possible Anti-anxiety Effect of Appetitive Aggression and a Possible Link to the Work of Donald Winnicott.

Various pleasant sensations that give a particularly intense pleasure are able to improve anxiety. In the present study I consider the possibility that their anti-anxiety action depends on the strong pleasure they provide, and I propose a possible mechanism of this action. According to some studies, also appetitive aggression (an aggression that provokes a strong pleasure and that is performed only for the pleasure it provides) can improve anxiety, and in this article I consider the possibility that the pleasure of appetitive aggression is able to reduce anxiety by the same mechanism I have proposed for other intense pleasurable sensations. The aggression performed by a child against the mother or against a substitute for the mother in the first period of life (a period in which this aggression is not dangerous) is a recurring theme throughout the work of of Donald Winnicott. Winnicott stresses that this aggression is necessary for the normal development of the child, and that the child must be free to practise it. According to Winnicott, this aggression is highly pleasurable and is not a response to unpleasant or hostile external situations. For these characteristics it seems to correspond to appetitive aggression in the adult that has been found to be able to reduce anxiety. Consequently, aggression performed by the child in the first period of life may also relieve anxiety, in the same way that appetitive aggression helps against anxiety in the adult. In his writings, Winnicott returns several times to an unthinkable or archaic anxiety that children experience when they feel abandoned by their mother for a period that is too long for them, and all children, according to Winnicott, live on the brink of this anxiety. In this study I propose the hypothesis that aggression in the early period of life may be necessary for children because the intense pleasure it provides may help them against this continuously impending anxiety.

The grammar of paradox: Deciphering Winnicott's language theory.

This paper illuminates how the psychoanalytic work of Winnicott and Wittgenstein's philosophy on language complement each other in elucidating a "psychoanalytic language game". The paper takes a close look at the grammar and linguistic mechanisms which underlie psychoanalytic work. Wittgenstein's linguistic turn from positivism is discussed; his ideas like 'family resemblance', 'aspect seeing' and 'language games' are examined in order to shed light on the paradoxical communication at play in Winnicott's potential space. The paper looks at the potentiality central to therapeutic work, arguing that it accords with what Wittgenstein calls the grammatical optative mode, as Freud already indicated in his theory of dreaming.

The Activity of Neutrality.

The author discusses the analyst's neutrality as an activity: a constantly moving position and an always-evolving process characterized by the analyst's thinking and curiosity about how to help the patient better know and become himself. The author maintains that neutrality is a cluster concept (Wittgenstein 1953) that includes a number of functions. Recent theoretical shifts regarding neutrality are briefly reviewed, and an illustrative clinical vignette is presented.