Obra completa. Del psicoanálisis a la psicología social.

Reseña de la obra completa de Enrique Pichon-Rivière. Del psicoanálisis a la psicología social, 1967-1977. Establecimiento, Introducción y Notas: Fernando Fabris, con la colaboración de Joaquín Pichon-Rivière. Paidós, 2023.

On the Belatedness of Psychoanalytic Clinical Writing.

The belatedness of analytic writing and its effects on analytic processes are explored through the concepts of nachträglichkeit and thirdness. The temporal gap between being with and writing about functions as a meaningful pause filled with opportunities for investigating unconscious pathways to the analyst's countertransference. The significance of analytic narration in affecting specific psychoanalytic developments is explored. The theoretical framework utilizes the concept of après coup, which brings to light new meanings in an afterwardness of time. Aspects of analytical writing dynamics are discussed as equivalent to those of nachträglichkeit. Analysts also deploy thirdness in constructing presentations of clinical material. This could be an intrapsychic third or an external figure representing an internal introjected third. A clinical vignette demonstrates the enhanced understanding achieved by writing. It specifically assisted in exploring the analyst's enactment relating to change in the setting, the background for which was a move to online analysis. This evoked infantile anxieties and painful confusions about loss. Historically, the patient had to navigate a path through miasmic ambiguities between reality and phantasy, truths and lies. A conclusion is reached, arguing that analytic processes extend beyond the duration of sessions, and that the processes of clinical writing can provide a significant contribution.

To Reveal or Not to Reveal, That Is the Wrong Question: Thoughts about Clinical Writing in Psychoanalysis.

This paper plays with the possibilities of writing about psychoanalytic work in different ways with different levels of disclosure about both patient and analyst. Various issues around anonymity, confidentiality, consent and identity are explored, highlighting the many questions that come up. These issues of how to write psychoanalytically are also addressed from the point of view of culture and the sociopolitical gestalt of our time.

Clinical Evidence, Triangulation of Perspectives and Contextualization. Part 1: The Beginning of Carla's Treatment.

We propose to critically evaluate and strengthen the level of clinical evidence in psychoanalysis, using a strategy of triangulating clinical phenomena from different perspectives and increasing contextual knowledge. Insufficient discussion of alternative hypotheses and limited contextual information are two Achilles heels of psychoanalytic case presentations. We examine the concept and quality standards of clinical evidence in psychoanalysis and related disciplines, with particular attention to the contribution of the three-level model (3-LM). We analyze the case of a patient treated with transference-focused psychotherapy (TFP), making explicit the theoretical-clinical agreements and disagreements of the authors. We discuss the strengths and limitations of triangulation and contextualization, concluding that they make clinical work and psychoanalytic writing more reliable, transparent, auditable, and replicable.

Ontological Psychoanalysis in Clinical Practice.

The author describes and then clinically illustrates what he terms the ontological dimension of psychoanalysis (having to do with coming into being) and the epistemological dimension of psychoanalysis (having to do with coming to know and understand). Neither of these dimensions of psychoanalysis exists in pure form; they are inextricably intertwined. Epistemological psychoanalysis, for which Freud and Klein are the principal architects, involves the work of arriving at understandings of play, dreams, and associations; while ontological psychoanalysis, for which Winnicott and Bion are the principal architects, involves creating conditions in which the patient might become more fully alive and real to him- or herself. The author provides clinical illustrations of the ontological dimension of psychoanalysis in which the process of the patient's coming more fully into being is facilitated by the experiences in which the patient feels recognized for the individual he is and is becoming. This occurs in an analysis in which the analyst and patient invent a form of psychoanalysis that is uniquely their own.

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.

Does it Appear to 'Resemble' Reality? on the Ethics of Psychoanalytic Writing.

This paper explores the intricate nexus of writing and psychoanalysis by addressing a key question: In what and how many directions should analytic writing be ethical? The author structures the argument across three axes. First, in an introduction, writing's role as a psychoanalytic invariant is emphasized. Then, an exploration ensues, delving into writing as praxis, navigating complex technical choices, from micro- to macro-perspectives in clinical vignettes, their autobiographical essence, their relevance as models for theory, self-revelation, etc. Lastly, a succinct epilogue considers the relationship between aesthetics and ethics in psychoanalytic writing.

The psychoanalytic setting: José Bleger's encuadre.

José Bleger's paper on the setting (encuadre) is integral to his 1967 book Symbiosis and Ambiguity. Relevant concepts from the book are summarised before examining his view of the setting as a "non-process" consisting of "constants", complementing the "variables" of the analytic process. Process and setting are related as figure and ground in Gestalt psychology. The ideally maintained setting is studied as a thought experiment, uniting the categories of institution, personality, body schema, and body. Deposited in the setting, the psychotic part of the personality, or "agglutinated nucleus", is a remnant of early symbiosis with the mother. Bleger distinguishes two settings: the analyst's and the patient's. The latter can only be analysed by strictly maintaining the former. Ritualisation of the setting denies temporal reality. De-symbiotisation is not always possible. A concept of "internal" setting is suggested, but Bleger nowhere mentions this and the concept is problematic, leaving open the question of how to listen to the silence of the setting. Bleger's concept of encuadre can be applied to constants (invariants) in the wider world, the psychotic part of the personality being deposited in everything that is familiar and felt to be constant, including technology, which creates a "platform" for human activity.

The aesthetic and affective matrix of pre-reflective sensemaking at the origins of the relationship between subject and world: A dialogue between Kant's Third Critique and psychoanalysis.

The authors discuss the relevance of aesthetic and affective experience at the heart of the human being's capability to relate to the world and to found relations of sense. Faced with anguish that the world can be meaningless and with fear of uncertainty/chaos, trust and hope are needed for the world to be a hospitable place for existence. Such experience is aesthetic, sensitive and affective before being rational, reflective and deliberative. Through a dialogue between Kant, Winnicott and Bion, it is shown how foundation of trust is based on two essential aspects: (1) The illusion that reality was created to allow us to live in it (namely, the fictionality is a prerequisite for each possible development of psyche) and (2) this illusion is not generated by a solipsistic activity of the human mind; rather, it is made possible starting from the primordial relationship with the other, by containing anguish, nourishing trust and hope, and supporting psychic development and elaboration of progressive forms of symbolisation. The authors discuss how these points have a profound aesthetic implication through deepening the reflection on the ontogenetic development of the psyche, the complex intertwining between primary and secondary processes, and clinical implications.

Gratitude, freedom and refusal.

This paper is an exploration of gratitude as a fundamental concept in psychoanalysis. Melanie Klein's classic article "Envy and Gratitude" (1957) named gratitude at one pole on an axis of human suffering and flourishing, but with a few notable exceptions, the article stimulated research into envy. This paper explores the historical and philosophical traditions that have, to some extent unconsciously, influenced our contemporary understandings of gratitude. The paper also works to explore the social and ethical meanings of gratitude as well as gratitude's psychoanalytic significance. The aim is to uncover the overall psychic significance of gratitude and its place in human flourishing.

On the question of the internal frame.

This paper attempts to expand José Bleger's classic, metapsychological descriptions of the psychoanalytic frame to formulate and emphasize the role of the analyst's internal frame in establishing a psychoanalytic observational perspective in the analytic situation. The rationale for doing so follows from clinical necessity, especially when working with patients and psychic organizations that are 'beyond neurosis' and in non-traditional settings such as distance and telemetric analyses. Clinically speaking, in its most effective state, the analyst's internal frame can inform the possibility of an observational vertex aimed at the intuitive grasp of psychic reality rather than a sense-based, empirical observation of parameters denoted by the elements of a consensually validatable social reality.

Freud's interpretation in "Medusa's Head" and some alternative psychoanalytic implications of Ovid's Medusa.

Freud's very brief 1922 paper on the beheading of Medusa by Perseus wisely concludes with a call for a further examination of the sources of the legend. A now widespread interpretation of this legend is based (often without acknowledgement) on an addition to traditions concerning Medusa made in Ovid's Metamorphoses. It is argued here that this Ovidian innovation has often been misinterpreted, and that a more careful reading of Metamorphoses supports neither a widely alleged exclusively vengeful portrayal of Medusa, nor Freud's portrayal of Medusa's decapitation as solely a pitiable and terrible symbol of castration. Instead, Ovid's complex treatments of myths involving Medusa, Minerva and Perseus present parallels with Kleinian insights into phantasy attacks on fecundity, and into imagined revivals of dead or damaged inside babies. Thus the "displacement upwards" of the fearful castrated maternal genital envisioned in Freud's "Medusa's Head" must stand beside a quite different "displacement upwards" of the life-giving maternal genital. Indeed, tradition holds that Medusa's beheading gives rise to the birth of vigorous twins. Together with allied details, this aligns Ovid's masterwork with theories that modify or displace the so-called "sexual phallic monism" that some believe taints Freud's theories of gender development.

Alan Roland: A Personal Reflection on the Legacy.

This appreciation of the work of Alan Roland reviews his pioneering contributions to the field of cross-cultural psychoanalysis based on the clinical experience with patients from non-Western cultures, most notably India and Japan.

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.

Was It Just a Dream? Aging and Dreaming the Psychoanalytic Process.

By revisiting the last years of a long psychoanalytic treatment of a female patient, a psychoanalyst reflects on her own development as a clinician and on the changes in her experience of psychoanalytic generativity. An increasing ability to understand patient's shifts between creativity and destructiveness brings about a different understanding of the process of mourning, while the shared aging of the analytic dyad highlights the difficulty of ending an analysis that has become a way of life.

On Endings and Authenticity.

As an introduction to the panel on "Aging, Dying, and the Analytic Process," and to the Focus of this issue of The Psychoanalytic Review, this article offers personal comments linked to affective neuropsychoanalytic theory, and advocates an ability to think about illness and death as an integral part of lived experience.

Trauma: open concept.

This paper presents and discusses two sets of theories concerning trauma. The first involves a contemporary social theory of "cultural trauma" and the second refers to psychoanalytic theories on psychic trauma. We argue that these two groups of theories have some relevant elements in common, despite social theorists' critique of psychoanalytic understanding on the matter. In our view, the most important meeting points between these groups of theories concern (a) the possibility to think that trauma is not welded to events but has a formation process, one of attribution of meaning, (b) that this process has a temporality of its own, and (c) that the environment (the objects, actors, and agents that compose it) has a fundamental and determinant role in trauma formation. Further, we suggest that trauma is still an open concept in psychoanalysis.