The significance of the ego in "The Ego and the Id" and its unfulfilled promise.

It is not well known that The Ego and the Id, where Freud presented his second model of the mind, and introduced a new role for the Ego, was ignored by many of the major theorists that followed. I will attempt to demonstrate the importance of this new view of the ego for clinical psychoanalysis, and what has been lost by its being ignored.

Searching for the analyst's reveries.

Over the last 20 years the post-Bionians have begun nothing less than to spell out the beginning of the metabolizing process (reverie) in the analyst's mind that takes place with under-represented mental states. This bold attempt leading to new discoveries, and its many possibilities for understanding patients, seems to have obscured differences amongst leading post-Bionians with regard to how they see the forms of reverie, and how they might best be worked with. With Bion's perspective as a background, this paper explores three approaches, and how they differ with regard to whether one follows the views of early or late Bion. Technical issues associated with these views are raised. A clinical example is offered as one way to use reverie.

THE SEARCH FOR PSYCHIC TRUTHS.

Emphasizing psychic truths as the major domain of psychoanalysis, the author explores the complexity of defining such psychic truths. It is suggested that thinking of levels of psychic truths is the most useful approach. How to understand trauma and historical truth within this context is examined. The role of the analyst as aiding the search for psychic truths, rather than functioning as psychic "truth teller," is discussed within the context of paradigmatic changes in the psychoanalytic method that form an emerging common ground.

Transformando a contratransferência sem forma em uma forma representável: outra perspectiva / Transforming the formless countertransference into representable form: another perspective

O autor explora várias ideias acerca de nossas reações contratransferenciais. Sugere que a reação do analista geralmente inicia em resposta ao uso da ação de linguagem por parte do paciente, quando ele, inconscientemente, utiliza palavras para fazer algo, o que leva o analista a também responder inconscientemente. O analista deve, primeiramente, conter, metabolizar e refletir acerca de sua contratransferência antes de iniciar o trabalho analítico. A partir daí, precisa representar, através de repetidas clarificações, como ocorre a ação de linguagem. Esse procedimento dá início ao que o autor chama de trabalhar dentro da contratransferência(AU)

The author explores various ideas about our countertransference reactions. He suggests the analyst's countertransference reaction usually begins in response to the patient's use of language action, where the patient unconsciously uses words to do something, which the analyst responds to unconsciously. The analyst must first contain, metabolize, and reflect on his countertransference before analytic work can begin. From this the analyst needs to represent, through repeated clarifications, how the language action takes place. This begins the process the author calls, working within the countertransference(AU)

El autor explora varias ideas acerca de nuestras reacciones contratransferenciales. Sugiere que la reacción del analista comienza generalmente en respuesta al uso de la acción del lenguaje por parte del paciente, cuando éste, inconscientemente, utiliza palabras para hacer algo, a lo que el analista responde también inconscientemente. El analista deberá primeramente contener, metabolizar, y reflexionar acerca de su contratransferencia para luego poder comenzar el trabajo analítico. A partir de ahí, el analista tendrá que representar, a través de repetidas clarificaciones, cómo ocurre la acción del lenguaje. Ese procedimiento da inicio al proceso que el autor denomina trabajar dentro de la contratransferencia(AU)

Nosso ofício vital / Our vital profession / Nuestra profesión vital

Como parte de nossa busca permanente a fim de ajudar pacientes a encontrar, ou reencontrar, o cerne do que significa ser humano, investigo neste trabalho mudanças múltiplas de paradigma no método psicanalítico que constituem novos pontos comuns entre, ao que parece, diversas vertentes. Isto conduz a novas ideias sobre como ouvimos e interpretamos, os objetivos do tratamento e a maneira como se dá a mudança.

In our continual search to help patients find, or re-find, the core of what it means to be human, this paper explores multiple paradigm changes in the psychoanalytic method that form a new common ground amongst seemingly diverse perspectives. This leads to fresh views of how we listen and interpret, the goals of treatment, and how change takes place.

En nuestra búsqueda permanente con el fin de ayudar a los pacientes a encontrar, o reencontrar, la esencia de lo que significa ser humano, este trabajo investiga múltiples cambios de paradigma en el método psicoanalítico que constituyen nuevos puntos comunes entre, al parecer, diversas vertientes. Esto conduce a nuevas ideas sobre cómo oímos e interpretamos, los objetivos del tratamiento y la forma en la que se produce el cambio.

The workable here and now and the why of there and then.

At an earlier time our work as analysts was easier. We searched for the repressed in order to make constructions that connected the past to the present symptoms. Making these connections conscious, based upon the continuing influence of the Topographic theory, was thought to be the curative factor in psychoanalysis. Freud (1912, 1914) briefly expressed the importance of working in the present but his main focus remained the importance of reconstructing the past. The importance of working in the present started to be fully articulated approximately 30 years ago, and has become a central part of most views on technique. However, it is the contention of this paper that, while there is general agreement on the necessity of working in the here and now, the understanding of what this means or why it is useful runs along parallel lines rather than leading to a central point. Further, it is my impression there is little agreement on the reasons for interpreting the there and then. The idea of a 'workable here and now' is introduced to capture how the here and now might best include the analysand's readiness to synthesize what is offered, while a theory of the necessity for working in the here and now and the there and then is offered.

'Can you push a camel through the eye of a needle?' Reflections on how the unconscious speaks to us and its clinical implications.

There has been a recent surge of interest in a type of thinking seen in some patients most of the time, and all patients some of the time. In the past it was simply called regressive thinking, but attempts to be more specific have led it to be called by various names, like 'pre-symbolic', 'pre-conceptual' and 'pre-operational'. What these labels attempt to capture is that the patient's thinking, at these times, is without representations and closer to actions. As a clinical phenomena I prefer to use Loewald's term, 'action-language', that is, where words become attempts to bore, seduce, anger, etc. It is different from when words are used to communicate internal states via free association. A case is made for action-language being the primary method by which the unconscious speaks to us in psychoanalytic treatment. This paper explores some of the reasons for this type of thinking, along with the clinical methods to find the thinker where there appears to be none. Distinctions will be made as to the use of the process versus the content, on the goal of interventions as bringing insight versus the capacity for insightfulness, and the model of treatment as leading to transformations in thinking, rather than lifting of repressions. A clinical example is presented to demonstrate these perspectives.

'I noticed': the emergence of self-observation in relationship to pathological attractor sites.

The author highlights self-observation as an important goal of psychoanalysis, separate from other concepts with which it is often confounded. To support this position, he presents clinical and developmental data, as well as observations by psychoanalysts on recent findings by cognitive neuroscientists. He introduces the term 'pathological attractor sites' to capture the challenge in moving from the belief in the reality of one's own thoughts to self-observation. Clinical techniques to deal with this specific challenge are presented.

A shadow concept.

The author focuses on the significance of preconscious thinking, and its relationship to what we think of as unconscious fantasies. He reopens Freud's forgotten struggle with preconscious thinking, while he explores preconscious thinking as the basis for thinking about psychoanalytic treatment. This includes our goals in bringing an idea to the analysand's attention, and the role of transitional space where thoughts and feelings can be played with.

Countertransference in defense enactments.

A clinical term is introduced to capture a defense that develops with the patient's deepening but fleeting awareness of painful transference feelings. The analyst's attention to countertransference in such situations is central to the analysis of these defenses. An attempt is made to distinguish defense enactments from other types of defenses, and to differentiate the analyst's countertransference reaction to this type of defense from countertransference reactions that might appear similar. The reasons for this dynamic in the interpersonal space are explored, and a clinical example that describes this phenomenon in the analytic moment is given.

Conflict theory/trauma theory.

There has been a tendency in psychoanalysis to view the effects of trauma, and our ways of working with it, as something separate from our understanding and techniques of working with intrapsychic conflict. While appreciating certain differences, the author explores, primarily via clinical examples, how an integrated perspective may be most helpful to our patients, especially in the area of the patient's capacity to reclaim feelings.

How can we know what we need to know? Reflections on clinical judgment formation.

What distinguishes a psychoanalyst from any other psychologically minded, empathic human being? This seemingly simple question goes to the heart of our profession, the way we see ourselves as competent clinicians. To understand a patient's material beyond ordinary empathy--that is, to come to a clinical judgment--we need to step out of the dyadic, countertransference situation and reflect what we've experienced in reference to our clinical theories. An analytic vignette shows how a theoretical background can be used to understand and interpret to a patient in a way that is deeply meaningful.