Playing, Paradox, and Analytic Activity Between Knowing and Being.

The author explores some ways that we help patients to hold paradoxical realities intrinsic to transference and play in analytic work. He suggests that Winnicott's guardianship of the setting for the emergence of playing raises questions about the role of neutrality in an ontological analysis. The author tries to demonstrate some ways that the work of helping patients to hold paradox in play overlaps with a concept that he has earlier referred to as an activity of neutrality. He explores how in the analytic process, understanding and being are two dimensions of the analytic process that work in concert with each other. Often the analyst works quietly in spaces between epistemological and ontological approaches in the holding of paradox.

The Oedipal Virtual Citadel: Varieties of Isolation, Oedipal Conflict, and Cover-Up.

The author elaborates some of the fantasies and defenses that protect some patients in their oedipal fixations, particularly those related to forms of personal isolation. To some extent, cover-up is intrinsic to oedipal conflict and fantasy, but what is covered up is quite variable. In this paper, the author highlights elements of personal isolation that the patient cultivates in order to protect love for a desired oedipal parent and the conscious and unconscious fantasies associated with this love. The patients described here use forms of personal isolation to cover up and secure the gratification of oedipal fantasies. Their isolation also serves to protect them from fantasies of unique forms of destructiveness in relation to self and the desired other. The citadel, a concept from Guntrip's description of defenses protecting the schizoid patient's fear of destructive love, is characterized here for the neurotic patient as virtual because in some ways, each of the participants in oedipal conflict turn a "blind eye" to a staged cover-up. Clinical illustrations examine the transference-countertransference process of shifts from turning a blind eye to sustaining a process of seeing what is being covered up but has already been seen.

The Play of Mourning.

Playing is a form of responsiveness that involves a shift from more formal interpretation about defense, unconscious fantasy, or transference to one that employs humor or irony regarding the content of fantasy or poses a more direct confrontation between internal fantasy and external reality. Playing is differentiated from more formal interpretation by the analytic couple's intensity of affective expression, the idiomatic language used to express affect or ideas, or the analyst's more personally revealing reaction to the patient's recruitment of him as an internal object. Two clinical vignettes show how play emphasizes experiences of loss and waste that have been enacted in the patient's life and often in transference-countertransference engagement. Through newly discovered forms of play, these processes are occurring now in real time between patient and analyst and less through frozen memorialization of what never was.

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.

Shared Catastrophe, Resistance, and Learning in the Countertransference.

In light of the 2020-2021 pandemic and consequent necessity for radical changes in psychoanalytic treatment, the author discusses transference-countertransference, resistance, and the analytic setting, among other themes. In particular, the author explores how elements of regression induced in patient and analyst during times of external challenge sometimes obscures elements of unconscious conflict and fantasy that analysis mobilizes and can help to elucidate. He explores an element of the analyst's work with his own resistance to learning about what this catastrophe means psychologically to our patients and to those trying to help them. Three illustrative clinical vignettes are present and discussed.

The Limit of Intimacy and the Intimacy of Limit: Play and its Relation to the Bad Object.

Attachment to the bad object has remained a durable, undertheorized clinical problem. With an extended clinical example, the experience of limit, in both patient and analyst, is examined as part of a dense undercurrent in the relationship, including transference, that gives rise to shifts in understanding the attachment to an unsatisfying internal object. Importantly, the patient's and the analyst's experiences of limit are "in play" during the process of changes in the patient's attachment to the bad object. The relation of patient and analyst to the patient's internal objects, including bad and unsatisfying objects, is where play itself begins. Limit itself is constitutive of play. The analyst's attempt to analyze his own thoughts and experience regarding limits in maintaining an empathic connection to the patient's psychic reality influences the patient's capacity to take in a new part of his or her experience.

Toward an Ethic of Play in Psychoanalysis.

Through three detailed clinical vignettes, the author explores the ethical undergirding of play. He defines play as a form of idiomatic responsiveness that emerges in the context of analytic intersubjectivity, one that can illuminate elements of fixed transference-countertransference enactment. The author outlines an ethic of play that considers whether the analyst's forms of responsiveness deepen and enliven the patient's understanding of unconscious fantasy, conflict, and internalized object relations. Play poses challenges and a potential risk for the analytic couple, since in play rules are often changing in the dialogue between the conscious and unconscious minds of the analytic couple.

A theory of the setting: The transformation of unrepresented experience and play.

The psychoanalytic setting can be defined in part by its functions. The setting operates as an auxiliary function for the analyst's capacities, which include containment, interpretation, as a participant in play, and supervisor of the setting. The setting houses the transition from unrepresented to represented experience. The setting is a location for the dynamic transit between vital, interactive elements of both containment and interpretation of the patient's unconscious and conscious experience. Process and non-process elements of the setting are always interacting with one another because the objects' internal fantasies of the setting are always juxtaposed with the constant, structural elements of the setting. The author attempts to further elaborate the relationship of play to understanding unrepresented experience.

Playing in the Darkness: Use of the Object and Use of the Subject.

Play in the context of the patient's sense of absence, loss, and compromised capacities for symbolization can be a link between unsymbolized experience and greater capacities for representation. Winnicott's concepts of play evolved as one of the ways that analysts translate unconscious and unrepresented experience. For many patients who have experienced absence, the analyst and the analytic setting are subjected to the patient's unconscious efforts to destroy and negate meaning and relatedness. For the analyst to be "used" as an object to be destroyed and to survive destruction, he must become a subject in the mind of the patient and in his own mind as analyst within the intersubjective field. The analyst's work with his own resistance is vital to becoming a changing subject and an object available for play in the psychoanalytic process.

The Analyst's "Use" of Theory or Theories: The Play of Theory.

Two clinical vignettes demonstrate a methodological approach that guides the analyst's attention to metaphors and surfaces that are the focus of different theories. Clinically, the use of different theories expands the metaphorical language with which the analyst tries to make contact with the patient's unconscious life. Metaphorical expressions may be said to relate to each other as the syntax of unconscious fantasy (Arlow 1979). The unconscious fantasy itself represents a metaphorical construction of childhood experience that has persisted, dynamically expressive and emergent into adult life. This persistence is evident in how, in some instances, long periods of an analysis focus on translating one or a few metaphors, chiefly because the manifest metaphorical expressions of a central theme regularly lead to better understanding of an unconscious fantasy. At times employing another model or theory assists in a level of self-reflection about clinical understanding and clinical decisions. The analyst's choice of theory or theories is unique to the analyst and is not prescriptive, except as illustrating a way to think about these issues. The use of multiple models in no way suggests or implies that theories may be integrated.

Clinical theory at the border(s): Emerging and unintended crossings in the development of clinical theory.

The author provides some scaffolding for thinking about emerging and unintended integrative developments in clinical theory. The emergent theory to which the author refers works at a different level of theoretical discourse than explicit attempts at comparative translation of psychoanalytic concepts or theories. In contrast, most of the theory that is explored in this paper involves clinical discourse aimed at solving important common clinical problems. The work of a group of authors (Jay Greenberg, John Steiner, Anton Kris, Michael Feldman and Charles Spezzano) is described as simultaneously embedded within a particular orientation while demonstrating a kind of unwitting reach to a broad swathe of analysts. Distinctions are made between this kind of linking of clinical theory versus self-consciously syncretic and integrative approaches to theory development. The author also discusses the educational implications of this emergent theory for teaching and learning during psychoanalytic training.

Self-criticism and unconscious grandiosity: transference-countertransference dimensions.

The problems posed in understanding and working through the patient's layers of self-criticism are challenging for both patient and analyst. In particular, this paper explores some countertransference phenomena related to underlying grandiosity embedded in self-criticism. For patients who are self-critical, analyzing grandiose elements may create further grounds for self-reproach or open up new modes of self-experience and freedom. The paper tries to focus on how the analyst's experience of the patient's self-criticism often shifts over the course of analytic work. It is important for the analyst to not be crippled by a fear of considering the relevance of underlying grandiosity in relation to self-reproach. Understanding this dimension of self-reproach can help elucidate why it is so durable and refractory to interpretation. The patient has a stake in holding on to this self-punishment because it perpetuates self-regulatory fantasies. These fantasies sometimes relate to the feeling that the patient will be more successful or better loved by holding on to aspects of self-reproach. Sometimes these fantasies are based in competitive or dominant strategies related to winning out or retaliating over parents or siblings.

An elusive aspect of the analyst's relationship to transference.

The author discusses the analyst's reactions to being the object of the patient's transference, noting that this topic has been somewhat neglected in the psychoanalytic literature because of the centrality of transference analysis to the psychoanalytic method. He identifies different dimensions of countertransference that relate to being a transference object and discusses these in the light of "objectionable" and "unobjectionable" transference. The analyst's relationship to theory is also discussed. To clinically illustrate his points, the author summarizes the case of a patient whose transference fantasies and attributions engendered quite contrasting reactions by two different analysts.

Privacy, reverie, and the analyst's ethical imagination.

The author illustrates varying ways of using and thinking about forms of analytic reverie and the analyst's privacy. He discusses a few different registers from which the analyst can illuminate points of transference-countertransference enactment. The modality by which the analyst communicates these formulations of unconsciously held object relations and defenses varies and includes verbal interpretation through symbolic speech, interpretive action (Ogden 1994a), and, at times, interpretations that involve a construction of the analyst's subjectivity put forward to enhance the patient's understanding of enactments of the transference-countertransference. The author develops a concept, the analyst's ethical imagination, defined as the ways in which we consider and anticipate the implications of our interpretations.

Prevention of demineralization by CO2 and Er,Cr:YSGG laser irradiation of overdenture abutments.

PURPOSE: To assess the effects of Er,Cr:YSGG and CO2 laser irradiation on the prevention of demineralization of overdenture abutments. METHODS: 32 human canines, premolars, and molars were acquired, cleaned, and scaled. They were randomly divided into two groups. Each tooth had two windows on the occlusal cut dentin. One window on each tooth was irradiated by either Er,Cr:YSGG or CO2 laser, while the other window served as a control. After pH cycling at pH 5.5 for 18 days and pH 4.7 for 16 days, the teeth were sectioned and analyzed using polarized light microscopy with water as the imbibing medium. RESULTS: The Er,Cr:YSGG irradiated dentin had a mean lesion depth of 207 +/- 27 microm while its control had a mean lesion depth of 209 +/- 34 microm. The CO2 laser irradiated dentin had a mean lesion depth of 185 +/- 24 microm while its control had a mean lesion depth of 205 +/- 22 microm. Based on paired t-tests Er,Cr:YSGG laser irradiation of dentin did not reduce demineralization when compared to the controls (P= 0.81), while CO2 laser irradiation of dentin showed that it helped reduce demineralization when compared to the controls (P= 0.025).