Aging, Dying, and the Analytic Process.

The panel discussion presented at the New York Psychoanalytic Society and Institute's 1066th Scientific Meeting held on June 8, 2023, takes up aging and dying of an analyst and their impact on patients and on the nature of analytic process. Participants reflect on conflicts and challenges arising with more analysts and patients living to an advanced age, on the unregulated nature of analysts' retirement, and on multilayered meanings of analysts' ethical commitment to their work.

Aggression and impulse control in the analysis of a young boy.

The analysis of a young boy with aggressive, impulsive problems is reported with an emphasis on technique. The step-by-step analytic work is reported to highlight the gradual emergence of the underlying function, determinants, and developmental context for such difficulties, which helped guide the analytic work. An important focus is on the analyst as a developmental as well as transference object, the use of nonverbal communication until interpretation could be tolerated, and the ways to facilitate the development of reflective function. Needing to address both conflict and developmental interference, the analyst was always guided by the level of mental organization when making interventions. The important work with the parents is also carefully described.

The story of Sam: continuities and discontinuities in development, transforming into and out of a perversion.

The aim of this paper is to suggest new ways of understanding development that offer new therapeutic possibilities. I use observational and interview data showing the development of one research subject over forty years to highlight that the concepts of continuity and discontinuity need to be considered together to grasp the full complexity of psychological development. In the subject an unanticipated transformation occurs at age 14, the emergence of a perversion, whichfades by age 28. I will show that the observations can be best understood by co-ordinating the influence of antecedents that exert a pull backward with the transformative potential arising from the pull forward into new structures, compromises, and organizations.

Conceptualizing transformations in child and adult psychoanalysis.

A study group on Conceptualizing Transformation in Child and Adult Analysis focused on a particular kind of change in analysis, that of transformational change, a change in organization that could not be predicted from what came before. We found that, based on careful presentations of four analytic cases, transformational or pre-transformational change did take place. A central intervening variable was the patient's development of a sense of agency. We tried to articulate the nature of the interventions leading to agency and ultimately to transformation. We added other new dimensions: an emphasis on construction in addition to reconstruction and a focus on the future.

Thoughts on medication and psychoanalysis: a lay analyst's view.

The issues involved in split analytic treatments-where a second person manages the patient's medication-are discussed from the point of view of a developmentalist and lay analyst. Case material is presented to illustrate the interplay of medication with other elements of the psychoanalytic situation. Medication and its effects, it is argued, should be accorded no special status apart from other interventions and enactments in an analysis. Some see medication and psychoanalysis as parallel processes, two separate and unintegrated theoretical systems, and recommend shifting back and forth between models of the mind or becoming "bilingual"; against this view, it is argued that anything the analyst does will affect the patient's thoughts, fantasies, and even physiology in individual ways, and only attention to analytic material can reveal what an intervention means in a specific case. Success in split treatment depends on a collaborative therapeutic alliance among patient, analyst, and consultant. Because there is as yet no theory that bridges psychoanalysis and psychopharmacology, analysts must talk of these matters as incompletely synthesized and regard them as part of the challenges that make psychoanalysis the exciting, impossible profession it is.

Gender and its clinical manifestations.

Based on a study of five analytic cases (three reported here), and using a modern classical psychoanalytic perspective in which both biology and social forces are integrated, our study group on gender investigated why for some gender assumes a distorted and exaggerated role in the subjective sense of self. Clinical material was used because we wanted data allowing us to study patterns emerging from an exploration of patients' unconscious fantasies as they shed light on the psychological significance and function of gender. We found that in each case gender disturbances were never primary but secondary to difficulties in integration, cohesiveness, separateness, stability of solid sense of self and of the object, to depression and especially to problems with aggression and rivalry which had to be analyzed first. Conflicted gender gave rise to solutions that were literal and concrete. Not surprisingly, in each case mothers wished for a child of the opposite gender and treated gender expression in highly ambivalent ways. In terms of technique we learned that ways of coping with rejection, evolving paternal transferences which allowed for metabolisis of the maternal relationship, and ego building techniques had to take place before conflicts around gender could be analyzed productively.

An analysis of a developmentally delayed young girl. Coordinating analytic and developmental processes.

Clinical material is presented from a multi-year treatment of a five-year-old girl with a variety of developmental interferences, making it necessary to consider whether standard technique would suffice. History includes the fact that she was adopted five days after birth and told as early as possible about her adoption; she was placed in a restrictive brace from four months to twenty months because of congenital hip displasia. Sandy's ability to let in the outside world was limited by her intense denial, not looking, not taking in, and by her detachment. Her passivity--whether a defense (modeled on her experience of physical restraint) or an arrest--was a formidable obstacle to the development of active transference moments. I use this case as an opportunity to look at the role of developmental sequences in the context of the analytic process. While I consciously did not do anything different than I would with any child analytic patient, I intuitively stressed certain kinds of interventions.