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.

Current Trends in Theoretical Orientation of Psychologists: The Case of Quebec Clinicians.

OBJECTIVE: Trends indicate that clinical psychologists' theoretical orientations have changed over the last decades in North America, but research on this topic in Canada is scarce. We analyzed the orientation of psychologists over the last 20 years in the province of Quebec, where 46% of Canadian psychologists are located. METHOD: Data were collected annually through the board registration form of Quebec psychologists' professional order from 1993 to 2013. Univariate statistical analyses were realized on aggregated data. RESULTS: In 20 years, the proportion of clinicians choosing cognitive-behavioral therapy (CBT) as their main orientation grew from 18.4% to 38%, while preference for other orientations slightly declined. Existential-humanistic and psychodynamic-psychoanalytic approaches remained the primary orientation for around 21.7% and 21.5%, respectively. In 2013 (N = 8608), when taking into account 2 choices of theoretical orientation, 55.8% of clinicians chose CBT, 34.3% existential-humanistic orientation, 27.9% psychodynamic-analytic theories, and 21.8% systemic-interactional orientation. CONCLUSIONS: Findings underline trends in Quebec clinical practice characterized by an increase in the number of psychologists identifying cognitive-behavioral approach as their primary self-reported theoretical orientation.

WHAT IS EFFECTIVE IN PSYCHOANALYTIC PSYCHOTHERAPY? A HISTORICAL REPRISE.

While psychoanalysis as a field has moved from the ideal of technical neutrality to a vision of the therapist as more human, real, and empathically engaged, relatively little attention has been paid to the implications of this evolution. For Freud, technical neutrality provided an important protection against bias and suggestion, one problematized by a view of the psychoanalyst's participation and influence as intrinsic to the therapeutic enterprise. The impact of this change on the evaluation of mechanisms of change is contextualized and discussed by the author.

A HISTORICAL REPRISE: SOME OBSERVATIONS ON PROGRESS IN PSYCHOANALYSIS.

The papers from the American Journal of Psychoanalysis 1956 and 1965 roundtables on what is effective in the therapeutic process are viewed through the lens of psychoanalysis' evolution over the past 50-60 years. With the passage of time, the contributions of the Interpersonal School to mainstream psychoanalysis have become clearer, especially with respect to mutative factors in the patient-analyst relationship. These papers from the 50s and 60s are also products of the internecine battles of the time, in which the different schools of psychoanalysis tried to claim absolute truth and assert hegemony in the field. The author argues that real progress in psychoanalysis has occurred through research and clinical/theoretical discovery, yielding an informed pluralism that mirrors the diversity and complexity of our work with patients.

Are psychiatric residents still interested in psychoanalysis? A brief report.

In spite of the efficacy of the psychodynamic psychotherapies, the number of young psychiatric residents interested in psychodynamic therapies is decreasing. Our psychoanalytical group, Genden (Genève-Denver), explored the possible reasons for psychiatric residents' hesitation to get psychoanalytic training. Five psychoanalytical psychotherapists met weekly for a year in order to debate that question, focusing on personal feedbacks from all of our 100 residents in psychiatry working with us for at least 4 years. Following the residents' responses, our focus group proposed ten commonsense feedbacks for psychoanalysts regarding stimulating young psychiatric residents' interest in psychoanalytic approaches.

Research in child psychoanalysis: twenty-five-year follow-up of a severely disturbed child.

In an era of managed care, psychoanalytic treatment of children is under fire as critics question whether the evidence of success in child analysis is sufficiently robust to warrant the large commitment of time and money required for this treatment. This article chronicles the history and current state of research at the Anna Freud Centre, and describes the evolution of a database that has methodically recorded and systematically organized data from over 750 cases of children referred to the Centre over a forty-five-year period. Analysis of this database has determined what kinds of childhood disorders are best treated with intensive psychoanalysis, and what kinds do not respond to this form of treatment. A long-term follow-up of a small sample of these childreen suggests the kinds of long-term benefits that can be gained when an individual is treated with intensive psychoanalysis as a child. As an example, clinical material from the analysis of an eight-year-old is presented along with follow-up interview data twenty-five years later.

Effectiveness of psychoanalysis and long-term psychodynamic psychotherapy on personality and social functioning 10 years after start of treatment.

The evidence on potentially greater benefits of psychoanalysis (PA) vs. long-term psychodynamic psychotherapy (LPP) is scarce. This study compared the effectiveness of PA and LPP on personality and social functioning during a 10-year follow-up from the beginning of the treatments. The eligible patients, 41 self-selected for PA and 128 assigned to LPP, were 20-45 years of age and had anxiety or mood disorder. Outcomes were analyzed using ten standard measures of personality and social functioning, carried out 5-9 times during the follow-up. Different change patterns by time in PA and LPP emerged, suggesting less benefit of PA during the first years of follow-up and more benefit in most outcomes thereafter. Greater post-treatment improvement in PA than in LPP was seen up to 1-2 years after PA had ended in more mature defense style (DSQ), level of personality organization (LPO), more positive self-concept (SASB), more improved social adjustment (SAS-SR) and sense of coherence (SOC). However, at the 10-year follow-up the differences were non-significant. In conclusion, PA may give some additional benefits when long-term aims are linked to personality and social functioning. The relatively small differences and higher costs in comparison to LPP may restrict the feasibility of PA.

Transference focused psychotherapy: overview and update.

This paper describes a specific psychoanalytic psychotherapy for patients with severe personality disorders, its technical approach and specific research projects establishing empirical evidence supporting its efficacy. This treatment derives from the findings of the Menninger Foundation Psychotherapy Research project, and applies a model of contemporary psychoanalytic object relations theory as its theoretical foundation. The paper differentiates this treatment from alternative psychoanalytic approaches, including other types of psychoanalytic psychotherapy as well as standard psychoanalysis, and from three alternative non-analytical treatments prevalent in the treatment of borderline patients, namely, dialectic behavior therapy, supportive psychotherapy based on psychoanalytic theory, and schema focused therapy. It concludes with indications and contraindications to this particular therapeutic approach derived from the clinical experience that evolved in the course of the sequence of research projects leading to the empirical establishment of its efficacy.

The mind: psychoanalytic understanding then and now.

The author discusses the evolution of psychoanalytic understanding from Freud's time to the present, citing the influence of various sociocultural changes. He addresses Freud's proper place in history and notes ways in which Freud's contributions cast him as belonging to Romanticism. Freud's shift from the topographic model of the mind to the structural one, and the influence of this on psychoanalysis, is discussed, as well as important developments in the field since Freud. The author focuses particularly on difficulties encountered in psychoanalytic practice today, and he describes what he has termed organizing interpretations as uniquely valuable in the treatment setting.

American psychoanalysis today: a plurality of orthodoxies.

American psychoanalysis, Freudian in origin, has recently developed in multiple directions among different groups in the current theoretical and clinical pluralistic atmosphere. The history of the effort to exclude new ideas is briefly reviewed. A survey of a group of leading analysts representing a variety of schools reveals a plethora of newer ideas, some areas of consensus, and broad areas of disagreement concerning the meaning and value of the ideas that dominate our current discourse. While we welcome the "pluralism" that has partially replaced the "rejectionist" policy of only a few decades ago, our contemporary pluralism is, to a surprising degree, a multiplicity of authoritarian orthodoxies, each derived from a particular thinker, rather than a scientific discourse. After a discussion of some aspects of the philosophy of science, the author suggests a controversial, but possible consensus view of American psychoanalysis today. The need for the creation of a psychoanalytic research effort, focused on efficacy, is emphasized.

Psychoanalytic psychotherapy in times of social crisis: The impact on therapeutic relationship.

Discussion on defining therapy factors develops along two lines: one focusing on the interpretation and another focusing on the relationship. Changes in the socio-economic circumstances, cultural particularities, dismissal of institutions, constant negation, lack of boundaries, confusion of roles, various family secrets revealed due to "collapses," major conflicts, violence and aggression filling the individual as part of both the internal and the external reality - all are known risk factors causing the individual to experience trauma either due the nature of the received stimuli/threats or due to the loss of the enabling/supportive environment. Also, this situation affects the analyst's psychic structure as well. The analyst will have to strike a balance between their own internal objects, which under the circumstances activate the analyst's own suppressed conflicts, and the multiple intense projections of the analysand. First of all, the internal struggles taking place in the analyst's psychism regarding their own griefs, frustrations, and conflicts concerning their adjustment to the current reality, as well as individual griefs relating to their narcissistic doubts and the projections of omnipotence they receive. The question is whether the analyst will go through a destabilization process, being overwhelmed by psychic stimuli in multiple levels, or react with "manic defences" resulting, perhaps, in the prevalence of anti-psychoanalytic dynamics on the transference - countertransference axis. A second line of thought involves the internal struggles taking place in the psychic structure of the analysand, and often the "meeting" of the latter with the analyst through the "parallel process." Finally, we think about the multiple - due to psychic tensions - instances of enacting (or acting out) and the setting being put to the test in terms of frequency, fees, difficulty of symbolic processing, and aggressiveness towards the interpretations and demands of the analyst as object introjected to the superego and requiring "compliance" to certain standards, the setting principles. We refer to the internal processes resulting from conflicts in the therapists' psychic structure as regards their own internal objects, life experiences, frustrations in relation to the parent/authority, adolescent conflicts with the system, political views, life philosophy, and sense of fairness. Issues are more complex in the therapy of children and adolescents. Their mental condition is affected by that of their parents. When it is hard for the therapist to become an object of identification and idealization, since all institutions around them have been undermined, confirming the adolescent's guilt-ridden fantasy aggression? How, then, will the therapeutic process move forward when models crumble; when parents are being proved weak and unable to receive the aggressiveness of the independence-gaining process; and when reverie fantasies cease to exist? Today, more and more often we see adolescents who cannot develop because they are involved in their own parents' unprocessed situations. Despite the aforementioned difficulties, the therapy space as a setting with boundaries and empathetic functions could function as a "womb" that will give birth to new mental life. And this life will bloom as long as therapists preserve intact within them their values and principles - and their ability for reverie!

E uno plurus: psychoanalytic psychotherapy in the age of pluralism.

Until 1970 the dominant theoretical framework in American psychoanalysis was Freudian ego psychology. Since then a number of additional theories, such as object relations theory (including, but not restricted to, the Kleinian approach), self psychology, relational psychoanalysis, and attachment theory have evolved and compete with contemporary ego psychology in the current marketplace of psychoanalytic ideas. There is considerable controversy about whether it is advantageous to work from one theoretical model and apply it to all clinical situations, or whether to utilize all the available paradigms, making judgments about which model or combination of them is most useful in a particular clinical situation or at a particular clinical moment. The latter approach might be termed pluralistic. Though a pluralistic approach is not without its philosophic and practical difficulties, such a perspective is helpful in understanding the complexity of human behavior and in facilitating therapeutic growth. A pluralistic approach is familiar to contemporary psychotherapists, who must utilize multiple frameworks in constructing biopsychosocial formulations of their patients. A pluralistic perspective is advantageous in promoting a therapeutic alliance, since it lends itself to a collaborative therapeutic process with patients. A brief clinical vignette is presented to illustrate these ideas.

The impending and perhaps inevitable collapse of psychodynamic psychotherapy as performed by psychiatrists.

This article documents the diminution over the past 25 years in the focus on training in psychodynamic psychotherapy in psychiatry residencies. The author contends that the diminution is currently at the point that it endangers the 'holding environment' necessary for the acquisition of this valuable skill. The article also outlines societal factors that contribute to this situation and societal responses that might be taken to counteract a decline in the practice of psychodynamic psychotherapy by psychiatrists.

A contemporary integration of modern and postmodern trends in psychoanalysis.

Postmodernism has appeared on the psychoanalytic horizon and with it brought change and some confusion. Although many link or even conflate it with relational and intersubjectivity theory, those views are as subject to a postmodernist critique as other analytic orientations. Postmodernism can also be seen as usefully informing the concepts of psychoanalytic narrative and psychoanalytic space. It should not be viewed as an organized theory or movement that would entirely replace modernist ideas in psychoanalysis. Indeed, valid critiques of both modern and postmodern psychoanalytic positions have been advanced. In this climate the need for a viable integration remains urgent. Bruno Latour's development of the concept of hybrid structure as a way of dealing with the same kind of impasse in the field of science studies is presented, along with its applicability to the dilemma faced by psychoanalysis.

The Efficacy of Psychoanalysis and the Analytic Therapies: Reflections of a Psychoanalyst and her Former Patients.

An informal statistical analysis of treatment modalities and succesful outcomes in the 55-year private practice of an experienced psychoanalyst is provided. Clinical examples in this personal account bring emphasis to value of the therapist-patient relationship.

Theory of drives and emotions - from Sigmund Freud to Jaak Panksepp. / Teoria emocji i popedów ­ od Sigmunda Freuda do Jaaka Pankseppa.

The article discusses the development of psychoanalytic theory in the direction of broadening the reflection on their own based on data derived from empirical studies other than clinical case study. Particularly noteworthy is the convergence that followed between neuroscience and psychoanalysis and the rise of the so-called neuropsychoanalysis. Consequently, this led to eject empirical hypotheses and begin research on defense mechanisms, self, memory, dreams, empathy, dynamic unconscious and emotional-motivational processes (theory of drives). Currently neuropsychoanalysis constituted itself as a discipline contained in itself three separate areas: the psychodynamic neuroscience, clinical neuropsychoanalysis and theory building. The article introduces the theory of Jaak Panksepp emotional systems as an example of anintegrated neurobiology of affect, behavioral biology, evolutionary psychology and psychoanalysis. The theory of emotional systems includes the description of the SEEKING system representing basic motivational system of the organism. Apart from a new perspective on the theory of drives described by Sigmund Freud, it offers the possibility to take into account the emotional and motivational systems within the understanding of mental disorders such as depression, addiction and psychosis, which is the core of psychoanalytic thinking.

What is conceptual research in psychoanalysis?

The development of psychoanalysis as a science and clinical practice has always relied heavily on various forms of conceptual research. Thus, conceptual research has clarified, formulated and reformulated psychoanalytic concepts permitting to better shape the findings emerging in the clinical setting. By enhancing clarity and explicitness in concept usage it has facilitated the integration of existing psychoanalytic thinking as well as the development of new ways of looking at clinical and extraclinical data. Moreover, it has offered conceptual bridges to neighbouring disciplines particularly interested in psychoanalysis, e.g. philosophy, sociology, aesthetics, history of art and literature, and more recently cognitive science/neuroscience. In the present phase of psychoanalytic pluralism, of worldwide scientific communication among psychoanalysts irrespective of language differences and furthermore of an intensifying dialogue with other disciplines, the relevance of conceptual research is steadily increasing. Yet, it still often seems insufficiently clear how conceptual research can be differentiated from clinical and empirical research in psychoanalysis. Therefore, the Subcommittee for Conceptual Research of the IPA presents some of its considerations on the similarities and the differences between various forms of clinical and extraclinical research, their specific aims, quality criteria and thus their specific chances as well as their specific limitations in this paper. Examples taken from six issues of the International Journal of Psychoanalysis in 2002-3 serve as illustrations for seven different subtypes of conceptual research.

The crisis of psychoanalysis and psychoanalytical training: the suffering of the candidate on the long road towards qualification.

The author assesses the impact of the so-called 'crisis of psychoanalysis' on the training of candidates, and on those who accompany them through the course. Different causes of the most relevant symptom of the crisis, i.e. the difficulty of finding patients for a four-sessions-weekly analysis, are considered. According to the author, analysts themselves must bear some of the responsibility for it. She draws attention to a number of interrelated phenomena, such as: trainees' tension in their encounters with potential analysands, due to awareness of their own needs as trainees; the necessity to accept very disturbed patients whose selection might arouse criticism from the training committee; analyses in which trainees seem to become patients' hostages because of ever-present fears of interruption; the difficult construction of a psychoanalytic identity in trainees who also are in full-time psychiatric practice; trainees' profound uncertainty about the future both of psychoanalysis in general and their own careers in particular. In agreement with Kernberg, the author stresses the importance of considering the 'crisis of psychoanalysis' as a phenomenon whose development may be influenced by the analysts themselves.

Theories of change in therapeutic work.

This article explores how theories of personal change differ from each other according to the assumptions made about the nature of the individual, the relationship between the person and the social, and the nature of causality. Three different concepts of the individual person are distinguished, namely, the autonomous, the expressivist, and the social individual. Each of these implies different relationships between the individual and the social, and different theories of causality. From the perspective of the autonomous individual, change in a person is a rational reordering of individual thought processes. The cause of any personal change is rational effort of the individual. Clinical psychology and psychoanalysis reflect this perspective. From the expressivist perspective, each individual has an inner urge to self-actualize which is the cause of change. Humanistic psychology is based on this view. From the perspective of social individuals, the individual is a cultural being, necessarily dependent on others, who only develops a mind in interaction with others. From this perspective, individual change cannot be separated from change in the groups to which an individual belongs.