What We Do, What We Say, What We Don't Say: Confidentiality In The Publication Of Clinical Writing.

Questions concerning analysts' publication of material from the analyses of their patients have troubled the field of psychoanalysis since its inception. Disguise inevitably distorts the clinical material and is often insufficient to protect the patient from recognition. Asking the patient's consent for publication intrudes upon and alters the analytic process. While analysts have largely reached a consensus about the need for anonymity in published material, there is still considerable debate about the necessity for obtaining patients' consent when using their material for publication. In this paper, I will trace the evolving meanings of disguise, and particularly of consent, in the analytic literature. I will place a particular emphasis upon the differing theoretical belief systems that underlie the analyst's decision to ask consent from her patient or not to do so, and I will argue that, although decisions on asking consent remain a complex matter, such coherent belief systems should play an important part in analysts' decisions regarding consent. I will illustrate my thought processes and some clinical situations with brief examples, and I will conclude with some practical recommendations, with the hope that these will stimulate further discussion in the analytic community.

Termination and repetition: The dissolution of the frame.

Beginning with Freud, analysts have observed that the pull to repeat is particularly strong as analysis approaches termination and that transferences that have come to light earlier in the analysis are revived and reworked at this time. It is also well known that primitive transferences, may make an appearance at the termination phase for what has been believed to be the first time. Drawing upon the work of Bleger, the author explores these primitve transferences and their relation to repetition. She argues that they are linked to the impending dissolution of the frame, and they are of two varieties, reflecting different levels of psychic experience. The upper level reflects symbiotic phantasies that have been invested in the frame; these have been repeated silently throughout the analysis in the daily operation of the analytic method and the arrangements of the analysis. The second, lower level, which involves somatic disturbance, disorganization, and loss of stable identity, is less clearly a repetition and less well elaborated in phantasy; this set of transferences reflects the disturbance of the deep structure of the setting, linked to bodily experiences of oneness with the early object. The author presents clinical material from the termination phase to illustrate the emergence of these two levels of primitive transference and the way they may be worked through.

From "Either/or" to "and": The Analyst's Use of Multiple Models in Clinical Work.

In our "post-pluralistic era" (Cooper 2015), analysts, perhaps particularly in North America, are exposed to a multiplicity of formal theories in their training and their reading; their clinical work often reflects ideas drawn from more than one of them. An aspect of this development is the analyst's mental process as she draws on heterogeneous models when with the patient and when processing the events of the session afterward. A number of questions arise here: How does a new piece of clinical understanding, representing an alternative theoretical perspective-one that is not usually at the center of that analyst's thinking-enter the mind of the working analyst? How can the analyst assess whether this is a useful piece of understanding? How can the new piece become assimilated in the analyst's broader thinking? That is, how can the analyst's practice influence her theory? (Canestri 2006).

The screen memory and the act of remembering.

Screen memories, seen by Freud, Greenacre and other analysts of a past generation as a key source of data for the reconstruction of psychic and historical reality, have been relatively neglected in contemporary analysis. A fresh look shows that these durable, constant memories have a dual relation to childhood experience: they memorialize both a specific organization of trauma, wish and defense, and a private childhood act of remembering. Close attention to the screen memory itself and the context in which it appears indicates that both aspects of screen memory have meaning for the individual and are represented in fantasy. Both currents of meaning can be seen in a literary screen memory and in the clinical situation, where both play out in transference and countertransference.

The wish for revenge.

The wish for revenge is a ubiquitous response to narcissistic injury, and particularly to the narcissistic injury that accompanies oedipal defeat. Vengeful fantasy serves to represent and manage rage and to restore the disrupted sense of self and internalized imagining audience that have resulted from injury. Clinical and literary examples demonstrate the split within the representation of the self and the imagining other that underlies the wish for revenge, and the way that this split operates differently in the psychic economy of the transiently and the chronically vengeful.