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.

"How Can I Trust You When I Know You Can Die?" Surviving the Death of an Analyst in a Child Analysis.

This reflection on the initial stages of treatment of a latency girl whose previous analyst died offers some insights into inner workings of mourning in children. The mourning process intersects in complex ways with a developmental stage, object constancy, unconscious phantasies, and conscious ideas about life and death. Clinical material illustrates some challenges that emerge in the transference-countertransference matrix when working with a child who lost both her primary object (the mother) and her transference object (the analyst). The reality of the analyst's death emphasizes that for a child patient the analyst is always a transference object and a real object at once.

What Should Health Professions Students Know About Countertransference in Inpatient Psychiatric Environments?

Inpatient psychiatric units are heavily regulated physical environments designed around the twin aims of treatment and containment. Less formally regulated but no less important are emotional norms and tones that also contribute significantly to psychiatric care environments. Inpatient psychiatric units are co-created by patients and clinicians, but clinicians have authority that patients do not. This means that clinicians' management of their own transference and reactions is clinically and ethically important. This article defines transference reactions and draws on case examples to canvass how positive and negative transference reactions can influence inpatient care of patients who are suicidal.

[Loss of contact between doctor and patient: early signaling can prevent escalation]. / Verbroken arts-patiëntcontact.

A good therapeutic relationship leads to better outcomes. In the event of an imminent break in contact, discussing the alliance rupture can be helpful. Optimal use of the countertransference also contributes. Metacommunication can be useful. In this article, some cases illustrating these concepts, are being discussed.

Structural Aspects of Synchronistic Moments in Psychotherapy-Findings of an Empirical Study of Synchronicities in Psychotherapy and Psychoanalysis1.

Synchronicity describes a meaningful coincidence of events, which is familiar to us from treatments of our patients, but unfortunately has not yet been empirically substantiated. Adding to previous findings that point out beneficial aspects of synchronicity (Marlo, 2022; Lagutina, 2021; Connolly, 2015), in this paper I will show through a series of five synchronistic moments which happened in the context of therapy and analysis and which have been documented empirically, how synchronicities occur and can be used therapeutically. In my research I found several situational factors that can be considered structural aspects of synchronistic moments. Furthermore, I will show that synchronistic phenomena can have a positive influence if certain relational and transference-countertransference referential aspects are considered by the therapist and analyst. The concept of synchronicity brings the possibility of a further therapeutical instrument for the patient-analyst-dyad.

La synchronicité décrit une coïncidence significative d'événements, qui nous est familière dans les traitements de nos patients, mais qui malheureusement n'a pas encore pu être étayée scientifiquement. Dans cet article - tout en allant dans le sens d'articles antérieurs qui montrent les aspects bénéfiques de la synchronicité (Marlo, 2022; Lagutina, 2021, Connolly, 2015) - je montrerai, à travers une série de cinq moments synchronistiques qui se produisirent dans le contexte de thérapie et d'analyse et qui ont été documentés de manière empirique, comment les synchronicités se produisent et comment elles peuvent être utilisées de manière thérapeutique. Dans ma recherche j'ai trouvé plusieurs facteurs situationnels qui peuvent être considérés comme des aspects structurels de moments synchronistiques. De plus, je montrerai que les phénomènes de synchronicité peuvent avoir une influence positive si certains aspects relationnels, et qui font référence au transfert-contretransfert, sont pris en compte par le thérapeute et l'analyste. Le concept de synchronicité offre la possibilité d'un instrument thérapeutique de plus pour la dyade patient-analyste.

La sincronicidad describe una coincidencia significativa de eventos, que nos es familiar a partir de los tratamientos de nuestros pacientes, pero que desafortunadamente aún no ha sido científicamente fundamentada. Sumándome a hallazgos previos que dan cuenta de aspectos beneficiosos de la sincronicidad (Marlo, 2022; Lagutina, 2021; Connolly, 2015), en este trabajo mostraré a través de una serie de cinco momentos sincronísticos que sucedieron en el contexto de la terapia y el análisis y que han sido documentados empíricamente, cómo suceden las sincronicidades y cómo pueden utilizarse terapéuticamente. En mi investigación encontré varios factores situacionales que pueden considerarse aspectos estructurales de los momentos sincronísticos. Además, mostraré que los fenómenos sincronísticos pueden tener una influencia positiva si ciertos aspectos relacionales y vinculados a la transferencia-contratransferencia son considerados por el analista - terapeuta. El concepto de sincronicidad brinda la posibilidad de un instrumento terapéutico más para la díada paciente-analista.

Institutional Transference in Serious Illness Care.

Institutional transference is a phenomenon describing patients' attitudes toward the institutions where they receive mental health or medical care. While transference toward individual clinicians in palliative care has been described, attitudes of patients with serious illness toward the institutions where they receive specialized care have not been described. Here, we present three cases which demonstrate the phenomenon of institutional transference in patients with serious illness and the resulting clinical implications, which include countertransferential responses of clinicians caring for them. We consider three conditions: (1) the idealized reputation of the academic cancer center, often a tertiary referral center; (2) loss of an institutional connection during care transitions; and (3) countertransferential reactions to institutional transference. We highlight characteristics and personality styles of individuals with cancer that may complicate and intensify institutional transference and identify potential interventions to address common challenges associated with institutional transference.

The Kvetch: Assessment, Pathogenesis, and Treatment of Patients Who Are Clinically Impaired by Chronic Complaining.

ABSTRACT: Clinicians often encounter patients whose presentations are characterized by long lists of complaints about their biological, psychological, interpersonal, and social conditions. The problems on which the complaints are based are variably reality-based and variably modifiable. Some of these patients display chronic complaining as a core, distinguishing feature. Accordingly, the aims of this article are to consider excesses of chronic complaining as psychiatric phenomena, explore possible pathogenetic contributions, describe approaches for treating conditions marked by clinically pertinent chronic complaining, and suggest areas for future research. Based on clinical observations enhanced by selective narrative literature review, we delineate and differentiate four groups of patients: 1) situational complainers; 2) chronic complainers due to unidentified medical problems; 3) mood-induced chronic complainers; and 4) personality-driven pan-dimensional chronic complainers. The last-mentioned group consists of help-seeking versus help-rejecting subtypes, the latter including a subset we designate as malignant chronic complainers. Strategies for managing these patients begin with detailed assessment of all complaints, ascertaining reality-based contributions to the complaints, including those initiated by patients themselves. Management approaches use specific biopsychosocial techniques based on patient-centered particulars. Psychotherapeutic strategies center on compassionate, empathic witnessing. Specific tactics include attending to unresolved grief and trauma, behavioral activation, cognitive and narrative restructuring and reframing methods, mentalizing and imaginal approaches, and psychodynamic methods including attention to attachment issues and transference. Sources of countertransference reactions to these patients should be identified and can be addressed. The many questions raised by these patients' presentations merit further research.

Anxiety, Desire, and the Object a: Lacan on Lucia Tower's "Countertransference".

Lacan's seminars are a treasure trove of innovative psychoanalytic explorations. In Seminar X, Anxiety, he takes up this Freudian theme and explores a number of interrelated ideas: castration, the difference between the sexes, two different forms of acting out, and what he terms his only original theoretical contribution: the object a and its "various incidences." The object a is described here in detail, especially in relation to Lacan's argument that analysts who are women have a freer relationship to their desire and the countertransferences it spawns than do men. Lacan discussed Lucia Tower's classic paper, "Countertransference," in light of these notions. This essay is a close reading of Lacan's close reading of Tower, whose account, he says, must be approached in all its "innocence and freshness."

Contribución al estudio de la mente del terapeuta (Deseos y Pensamientos) relacionado con la Contratransferencia en el contexto de la Supervisión / Contributions to the studies of the therapist's mind (whishesand thoughts) related to the countertransference in the contextofsupervision

El presente trabajo se centra en un estudio preliminar en aras de aplicar el Algoritmo David Liberman (ADL) como instrumento en el campo de la supervisión en un texto, tomado como informe de un supervisante, que pretende tratar el problema relacionado con el cambio psíquico desde las intervenciones del analista y desde una dificultad que surge con el uso que hace el paciente de la intervención para atacar al análisis. Comienza con un estudio de un enactment contratransferencial relatado por el analista, y luego analiza la construcción teórica presentada por él, identificando que su elaboración conceptual aún era inducida por el influjo del discurso del paciente. El énfasis de la investigación propuesta es aplicar la taxonomía de las intervenciones junto a la perspectiva de los errores del pensamiento aportadas por Maldavsky (2017). Se propone articular la práctica clínica y la elaboración conceptual, tal como ocurre en la supervisión AU

The present work presents the possibility of applying the David Liberman Algorithm (ADL) as an instrument in the field of supervision, from a text taken as a report by a supervisor, which aims to address the problem related to psychic change from the analyst's interventions and of a difficulty that arises from the patient's use of the intervention to attackthe analysis. It begins with a study of a countertransferential enactmentreported by the analyst, and later analyzes the theoretical construction presented by him, identifying that his conceptual elaboration was still induced by the influx of the patient's speech. The emphasis of the investigation lies in developing a foundation regarding the link between clinical practice and conceptual elaboration, guided by the categories related to the taxonomy of interventions and origin, function and errors of thought presented by Maldavsky, as occurs in a supervisión AU

Passivity as a defence and disguised destructiveness.

In this paper, I set out to describe the different viewpoints, conceptualisations and defence mechanisms of the state of passivity; the categorisation by Freud; how the perspective of his thinking was altered by later insights and clinical observations; the close connection between the superego, passivity and masochism; the significance of the internal object world for Melanie Klein; countertransference as a means of access to masochism and destructiveness, with the aid of a short case illustration; and, finally, Betty Joseph's clinical experiences in work with her patients.

On Becoming And Being A Subject Of Sexual Desire.

Emergent erotic desire, it is proposed, becomes represented in the mind and body through identification with caregivers as subjects of desire. Here the focus within desire is on erotic desire for another person, both desire for and the wish to be desirable to particular others. Children are seen to identify with caregivers' modes of embodying erotic desire for others (including ways of moving, dressing, relating, and so on that they fantasize as expressing erotic desire for others) in order to represent, psychically and bodily, their emerging erotic desire. These identifications-desire identifications-have a role in representing desire for others that is comparable to the role played by gender identifications in the representation of gender. Embodiments of desire for others, it is argued, are distinguishable (momentarily) from embodiments of masculinity and femininity. These embodiments of desire are routinely characterized, erroneously, as masculinity or femininity by caregivers and culture, and this misrecognition of desire for others as gender is traumatic to the self in its formation as a subject of desire. An extended clinical case is presented to illustrate how desire identifications might arise in the analytic dyad, relationally, bodily, and erotically in the transference-countertransference.

Navigating Countertransference in Inpatient Settings: Optimizing Interventions for Patients with Borderline Personality Disorder and Repeated Acute Hospitalizations.

Over the years, the psychiatric inpatient treatment paradigm has shifted to more brief stays focused on acute stabilization and psychopharmacologic-focused interventions, rather than individual psychotherapeutic engagement. Unfortunately, this has allowed patients with complex interpersonal dynamics, particularly borderline personality disorder, to slip through the cracks of effective treatment. This can contribute to repeated inpatient admissions, where both patients and clinicians feel trapped in a maladaptive, unhelpful cycle. In this article, we examine the evolution of inpatient treatment with de-emphasized psychotherapy practices, review the particular dynamics that patients with borderline personality disorder may evoke within an interdisciplinary treatment team, and provide a framework of clinically based vignettes for scenarios that may arise within inpatient treatment of this patient population. With attention to countertransference patterns and common pitfalls of communication, we offer alternative approaches and conversations with the hopes of improving outcomes and alliances in a new landscape of psychiatric practice.

On the analytic transference.

This paper is a presentation of the concept "transference" in psycho-analysis. In Freud's thought, transference movements are new editions, copies of tendencies or phantasies that are the repetition of infantile prototypes, relived with a lively feeling of actuality. The text shows Freud's reflection on transference, and the importance of the countertransference which has been much developed by the post-freudians authors. Then, the principal forms of transference are presented, for example passionate transference, or transference by reversal. The psychoanalytic reflection about transference leads to study the analyst's neutrality, and to pay attention to the setting of the sessions. André Green emphasizes that the transference that is addressed to the analyst is at the same time a transference on the setting and on to speech. In the complexity of the "analytic situation" (Donnet), speech is transformed under the effect of the transference address (Rolland).

Field theory: The transference-countertransference relationship and second look.

This paper examines the characteristics and clinical utility of the psychoanalytic field theory proposed by M. and W. Baranger, with particular emphasis on the issues of the transferential-counter transferential relationship and the 'second look'. The role of central key metaphors embodied in the experience of both patient and analyst is illustrated through the author's personal experience and participation in Three Level Model (3LM) work groups. The risk of moments of intense communication between patient and analyst has the possibility for the analyst to lose distance, making it necessary to go beyond moments of emotional resonance and reverie and to take a "second look" to understand the analyst's involvement in the interactional process in order to prevent the constitution of bastions of the field. The 3LM work groups extend the temporal context to include longer periods of time and a "third group look" that triangulates perspectives through group discussions, allowing for the exploration of transformations that have occurred in the analysis. The field perspective contributes to a deeper understanding of the transference-countertransference relationship. The "second" and the "third look" broadens the analyst's insights and enriches the understanding of the psychoanalytic process and its multifaceted dynamics.

The enigma of transference. Freud's discovery and its repercussions.

This brief introduction gives an historical outline of the development of the concept of transference in the different psychoanalytic traditions. It goes back to the various meanings of the German term "Übertragung" - transference, transcription, transmission, transposition and assignment - and how they were accentuated by the different psychoanalytic schools. The paper depicts the transition from a mainly intrapsychic understanding of transference as repetition to a more bipersonal and intersubjective approach exploring the different meanings of "intersubjectivity" and the forces that operate within the analytic field. Major developments arose from a new understanding of the role of the analyst's countertransference and the detection of transference mechanisms in narcissistic, borderline and psychotic states. The exploration of different forms of splitting and projective and introjective identification deepened the understanding of the analytic communication and led to concepts like "acting in", role-responsiveness, "actualization" and "enactment". As the author tries to show, all these approaches can find a legitimization in Freud's original writings, but the main differences concern technical issues, i.e. the interpretation of transference.

The importance of self-experience and self-reflection in training of cognitive behavioral therapy.

PURPOSE: Self-awareness can be characterised as impartial, non-judgmental thoughtful attention towards the self. Self-reflection in therapy is when a therapist reviews their experiences, thoughts, and behaviours concerning therapy and changes them as needed to enhance the therapeutic process. Therapists with good quality self-reflection can make more effective and ethical decisions, differentiate their own needs from clients', understand transference and countertransference, and consider the optimal response during a session. Practising the CBT approach and reflecting on one's own experiences can be essential for successful therapeutic development. Furthermore, self-reflection forms the basis of a fruitful therapeutic relationship and the therapist's self-confidence and sense of competence.

What might be in so close that as psychoanalysts we miss it?

What if the author were to position herself as a liar? Not of conscious lying, but an ignorance of what is so close to our collective noses that as psychoanalysts we miss it. Drawing on Harari's (2011) description of liberal ideology, the author suggests that our contemporary psychoanalytic focus on feelings, countertransference, and intuition is more determined by our cultural era than generally recognized. It is suggested that prevailing ideology may at times serve a defensive function. The author discusses a 1970s clinical seminar in which Bion observes that the presenting analyst's attention to feelings is "excusing" the patient (and himself). A second example, from Bion's Cogitations (1991), underscores the complexity of being sensitive to a patient's feelings without gratifying narcissistic demands. A final example is taken from the author's work in which there was a pressure to allow the patient's infantile feelings to determine the analysis. It was subsequently recognized that neither the patient's feelings nor the analyst's understanding were the site of authority in the analysis. Rather, authority lies in the analytic process itself.

Clinical Implications of Countertransference in the Treatment of Addictions.

The author provides a historical overview of the psychodynamics of addiction with particular emphasis on countertransference awareness and its relationship with treatment outcomes and prognosis. Countertransferences that frequently occur in the treatment of substance use disorders include shared helplessness, hopelessness, sadness, anxiety, fear, anger, rage, shame, and guilt. These emotional states in clinicians may lead to fatigue, avoidance, and acting out unless therapists are able to ground themselves and disidentify with the projected affective states. Positive emotions may lead to excessive enthusiasm in clinicians and deflect from the therapeutic process, resulting in deviation from established practice guidelines. Coexisting negative and positive affective states may lead to rescue fantasies and transgressions of boundaries. Contemporary psychodynamic clinicians appreciate the quantitative aspect of emotional reactions, where countertransferences accumulate exponentially over time, causing allostatic overload and compassion fatigue. Unanalyzed negative countertransferences are linked to either clinical avoidance or aggression, resulting in withdrawing care, failure of empathy, and dissolution or fragmentation of the therapeutic alliance. The negativism associated with the treatment of addictions may be rooted in unanalyzed countertransferences and psychosocial factors such as internalized negative societal attitudes and stigma. Degrading and dehumanizing attitudes toward people with substance use disorders could stem from internalized negative societal constructs against disenfranchised, minoritized, and stigmatized persons. This editorial introduces the work of Bernardine Han, an addiction psychiatrist who utilizes psychodynamic concepts to guide interventions with people with substance use disorders.

Melville's "Bartleby, the Scrivener: A Story of Wall-Street": The Vicissitudes of Treating a Difficult Patient.

Taking the liberty of imagining the lawyer in Melville's "Bartleby, the Scrivener" as narrator/therapist and Bartleby as patient, this article, written with the therapist/reader in mind, traces the vicissitudes of countertransference and speculates on what constitutes a "good enough" therapeutic effort.