Working online due to the COVID-19 pandemic: a research and literature review.

Given the contemporary situation of many analysts in the world now being forced to work online due to the effects of the COVID-19 pandemic, it is important to review the working online issue. Substantial debate over previous years has questioned whether a genuine analytic process can unfold through online work. This debate is reviewed with the conclusion that such a process is not necessarily precluded. Research outcomes are then reviewed to highlight those things that can facilitate positive outcomes when working online. These cover the 'online disinhibition effect', the therapeutic alliance, particular ways of using the screen, focussing on trauma, the importance of self-awareness, knowing the predictors of mental health, certain potential positives of isolation/quarantine and psychotherapy interventions that may be currently needed. Final recommendations and suggestions are then presented as in the diagnosis issue, professional development and guidelines to do with practical and ethical considerations.

Etant donnée la situation actuelle dans laquelle beaucoup d'analystes dans le monde sont maintenant obligés de travailler en ligne du fait des effets de la pandémie de COVID-19, il est important de revisiter le sujet du travail en ligne. Dans les dernières années, il y a eu un débat important sur la question de savoir si un authentique travail analytique pouvait se déployer dans le cadre d'un travail en ligne. Ce débat est revisité ici avec la conclusion qu'un tel processus n'est pas nécessairement rendu impossible. Les résultats de recherches sont alors étudiés afin de souligner les éléments qui peuvent faciliter des effets positifs quand on travaille en ligne. Cela recouvre 'l'effet de désinhibition du travail en ligne', l'alliance thérapeutique, les manières particulières d'utiliser l'écran, se concentrer sur le traumatisme, l'importance de la conscience de soi, la connaissance des indicateurs de santé mentale, certains aspects potentiellement positifs de l'isolation/la quarantaine et les interventions psychothérapeutiques qui peuvent alors être avisées. Des recommandations et des suggestions sont enfin présentées au sujet du diagnostic, de la formation continue et des consignes sur les considérations pratiques et éthiques.

Dada la situación contemporánea de muchos analistas en el mundo forzados en la actualidad a trabajar en línea debido a los efectos de la pandemia COVID-19, es importante revisar el tema del trabajo online. Durante los años previos, un debate sustancial ha cuestionado si un genuino proceso analítico puede llevarse a cabo a través del trabajo online. Este debate es revisado con la conclusión de que semejante proceso no está necesariamente impedido. Los resultados de la investigación son luego revisados para destacar aquellos elementos que pueden facilitar resultados positivos al trabajar online. Los mismos abarcan, 'el efecto online de desinhibición', la alianza terapéutica, los modos particulares de usar la pantalla, el focalizarse en el trauma, la importancia del autoconocimiento, el conocer los predictores en salud mental, ciertos potenciales positivos del aislamiento/cuarentena e intervenciones en psicoterapia que pueden ser necesarias en la actualidad. Se presentan recomendaciones finales y sugerencias, en el tema diagnóstico, desarrollo profesional y guías con consideraciones prácticas y éticas.

The Development and Psychometric Evaluation of the Group Schema Therapy Rating Scale - Revised.

BACKGROUND: Recent research has supported the efficacy of schema therapy as a treatment for personality disorders. A group format has been developed (group schema therapy; GST), which has been suggested to improve both the clinical and cost-effectiveness of the treatment. AIMS: Efficacy studies of GST need to assess treatment fidelity. The aims of the present study were to improve, describe and evaluate a fidelity measure for GST, the Group Schema Therapy Rating Scale - Revised (GSTRS-R). METHOD: Following a pilot study on an initial version of the scale (GSTRS), items were revised and guidelines were modified in order to improve the reliability of the scale. Students highly experienced with the scale rated recorded GST therapy sessions using the GSTRS-R in addition to a group cohesion measure, the Harvard Community Health Plan Group Cohesiveness Scale - II (GCS-II). The scores were used to assess internal consistency and inter-rater reliability. Discriminant validity was assessed by comparing the scores on the GSTRS-R with the GCS-II. RESULTS: The GSTRS-R displayed substantial internal consistency and inter-rater reliability, and adequate discriminate validity, evidenced by a weak positive correlation with the GCS-II. CONCLUSIONS: Overall, the GSTRS-R is a reliable tool that may be useful for evaluating therapist fidelity to GST model, and assisting GST training and supervision. Initial validity was supported by a weak association with GCS-II, indicating that although associated with cohesiveness, the instrument also assesses factors specific to GST. Limitations are discussed.

Promoting Behavioral Change in Psychoanalytic Treatments.

One of the shibboleths of psychoanalysis is that treatment should not target behavioral change, focusing instead on gaining insight and the therapeutic relationship (Freud, 1917; 1923; Gabbard, 2014; Greenson, 1967). Such an approach is believed to be accompanied by disruptions of exploration or problematic distortions of the transference (Freud, 1917; 1923; Gabbard, 2014; Greenson, 1967). However, ignoring behavioral change can put patients at increased risk for stalemates in treatment and persistent problematic behaviors that interfere with improvement and impair relationships. This article suggests that rather than being at odds or disruptive, efforts at behavioral change can be part of the development and employment of a psychodynamic formulation, and can be used to enhance self-understanding and exploration of the transference. Psychoanalytic approaches provide strategies for behavioral change not included in other psychotherapeutic treatments. This article describes a variety of ways in which efforts at behavioral change can be integrated with and enhanced by psychodynamic exploration.

Silicon in 'pure gold'? Theoretical contributions and observations on teleanalysis by videoconference.

Ideas about psychoanalysis via videoconference-videoconference teleanalysis (VT)-are presented with the general understanding that these settings produce a twofold split between various degrees of recognition/negativisation of the absence of the other, on one hand, and the expectation of physical co-presence, on the other. This split has been put forward as dismantling the here, now, with me pre-reflexive unity of the analytic experience. This article suggests that both members of the analytic dyad will seek to reappropriate the experience through a forced ego integration that interferes with accessing states of unintegration in the analytic treatment and produces subtle alterations to symbolisation work. The effort to overcome this condition is illustrated with clinical vignettes and therapists' comments about feelings of inauthenticity and discontent when trying to sustain evenly-suspended attention, as well as in the perception of a form of flattening of the alive nature of speech. However, this is not a constant for all VT, and mutual understanding can be an important mitigating feature. The focus of the discussion should be on the capacity of the analytic dyad to overcome such a split and not on a direct extrapolation of the perceptual limitations of VT to possible effects on transference / countertransference.

Naturaleza de la acción terapéutica del psicoanálisis / Nature of the therapeutic action of psychoanalysis

Resumiré los cuatro puntos principales de la hipótesis que expondrá en el trabajo: 1. El resultado final de la terapia psicoanalítica es permitir que toda la organización mental del paciente neurótico, detenida en un estadio infantil del desarrollo continúe su progresión hacia la condición normal del adulto. 2. La principal alteración efectiva consiste en una modificación cualitativa profunda del superyó del paciente, de la que se derivan, en general automáticamente, las otras alteraciones 3. Esta modificación del superyó del enfermo se lleva a cabo en una serie de innumerables pasos pequeños, por la acción de interpretaciones mutativas que efectúa el analista en Virtud de que es el objeto de los impulsos del ello del paciente, y debido a su posición de superyó auxiliar. 4. El hecho de que la interpretación mutativa sea el factor operativo esencial en la acción terapéutica del psicoanálisis no implica la exclusión de otros procedimientos (tales como la sugestión, el apoyo, la abreacción, etc. ) como agentes en el tratamiento de algún enfermo en particular (AU)

I shall conclude by summarizing the four key points of the hypothesis presented earlier: The final outcome of psychoanalytic therapy is to allow the neurotic patient´s entire mental organization, halted at an infantile stage of development, to continue its progression towards the normal adult condition. The principal effective disorder comprises a profound qualitative change in the patients superego, from which, generally speaking automatically, the other disorders originate. This change in the patient´s superego takes place in a series of innumerable small steps, through the action of mutative interpretations effectuated by the analyst by virtue of his being the object of the patients id impulses, and on account of his position as auxiliary superego. The fact that mutative interpretation is the essential operative factor in the therapeutic action of psychoanalysis does not predicate the exclusion of other procedures (such as suggestion, support, abreaction, etc.) as agents in the treatment of a particular patient (AU)

Transferencia y cambio psíquico en la clínica psicoanalítica de hoy / Transference and psychic change in psychoanalytic clinical practice today

Planteo en este trabajo la hipótesis de que la transferencia, tomada desde el vértice del Agieren, puede contribuir realmente al cambio psíquico. El Agieren transferencial, junto con su interpretación y/o construcción, puede tener un valor mutativo. El libro de Laurence Kahn L`écoute de l´analyste ha sido para mí una fuente de inspiración. Para demostrar mi hipótesis presento tres casos clínicos, en los que voy a centrarme en la emergencia de la crisis transferencial [Agieren] en el proceso de la cura y en sus efectos, mirados desde la perspectiva del cambio psíquico. A través de la primera paciente, he tratado de mostrar que gracias al Agieren transferencial, que reactualizó una situación traumática con el analista, se pudo desvelar y transformar una identificación inconsciente alienante, propiciando un cambio psíquico. El segundo paciente me ha permitido postular que la función historizante de la transferencia, junto con su interpretación y/o construcción, abre la posibilidad del cambio psíquico, pues permite al yo transformar la repetición pulsional atemporal en un tiempo subjetivo. La tercera paciente pone en acto en la transferencia un nudo infantil, ligado a un pacto de incondicionalidad con la madre. A través del proceso de perlaboración se pudo descubrir la parte de su realidad psíquica que alteraba la percepción de la realidad y transformar las antiguas investiduras en una nueva mirada sobre las posibilidades que ofrecía la realidad (AU)

In this paper I consider the hypothesis that transference, considered from the vertex of Agieren, may contribute towards psychic change. Transferential Agieren, together with its interpretation and/or construction, may have mutative value. To illustrate my hypothesis, I present three clinical cases where I shall focus on the emergence of the transference crisis [Agieren] in the process of the cure and in its effects, considered from the perspective of psychic change. With the first patient I show that by virtue of transferential Agieren, which reactualized a traumatic situation with the analyst, an alienating unconscious identification was revealed and transformed. The second patient enabled me to postulate that the historicizing function of transference, together with its interpretation and/or construction, introduces the potential for psychic change, by allowing the ego to transform atemporal drive-related repetition into subjective time. The third patient enacts an infantile node in the transference, bound up with a pact of unconditionality with the mother. Through the process of perlaboration the part of her psychic reality which altered her perception of reality could be discovered, and old investments could be transformed into a new way of looking at the possibilities this opened up (AU)

Lo arcaico en la sesión: la angustia y el vacío / The archaic in the sesión: anxiety and emptiness

Lo arcaico constituye el material fundamental de las sesiones analíticas, aunque no aparezca de forma explícita. Está constituido por lo pulsional y por la huella y el modelo de funcionamiento mental que han troquelado los acontecimientos cargados emocionalmente, ocurridos durante los primeros años de la Vida. Lo arcaico más determinante sobre la Vida psíquica es el Vacío que dejó la ausencia de acontecimientos que deberían haber ocurrido y no ocurrieron. El vacío actúa como atractor de posteriores acontecimientos deficitarios o traumáticos. En el futuro, lo que no existió se manifestará como amenaza de vacío o angustia de desestructuración. Lo arcaico aparecerá oculto por el lenguaje verbal, cuyos mecanismos de defensa evitarán el recuerdo de situaciones de vulnerabilidad y desvalimiento que vivió el niño y, probablemente, repitió el adulto. Esas situaciones de desamparo reflejan heridas narcisistas y producen un intenso sentimiento de vergüenza. Sin embargo, el sentimiento más terrible es el de vacío. Lo arcaico es el principal obstáculo con el que nos enfrentamos los analistas, porque es la causa fundamental de la compulsión de repetición y de la tendencia al despliegue de mecanismos defensivos frente a la angustia de desestructuración (AU)

The archaic constitutes the fundamental material of the analytic session, although it does not appear in an explicit form. It is comprised of the instinctual drives, and by the trace and model of mental functioning, imprinted by emotionally-charged events occurring during the early years of life. Of the archaic material, the greatest determinant upon psychie life is the void left by the absence of events that should have taken place, but did not. The emptiness or void acts as an attractor of subsequent deficient or traumatic events. In the future, that which did not exist will manifest itself as the threat of emptiness or distructuring anxiety. The archaic will appear concealed by verbal language whose defense mechanisms will prevent the memory of situations of vulnerability and distress or helplessness experienced by the child and, in all probability, repeated by the adult. Those situations of helplessness reflect narcissistic wounds and produce an intense feeling of shame. However, the most terrible feeling is that of emptiness. The archaic is the principal obstacle faeed by analysts, as it is the fundamental cause of repetition compulsion and of the tendency to deploy defense mechanisms in the face of distructuring anxiety (AU)

La gravitación del objeto en los pacientes fronterizos: una propuesta complementaria a los desarrollos de André Green / The gravitation of the object in borderline patients: a complementary proposal to the developments of André Green

El trabajo comienza mencionando que hay dos periodos en la obra de André Green, en lo que se refiere a su conceptualización de los pacientes fronterizos. Tras caracterizar la forma en que fueron tematizados en el primer periodo y hacer algunas referencias a las modificaciones posteriores, centra su interés en el rol del objeto malo en estos pacientes y en las distintas descripciones que Green ha dado del mismo y de su actitud. Posteriormente pone en relación estas variaciones en la actitud del objeto, con los distintos momentos del circuito del deseo de ser del paciente. De este modo, señala que, cuando dicho deseo no está activado, el objeto aparece teniendo un rol estructurante. Cuando comienza a activarse, el objeto se torna amenazante y ataca y aterroriza al sujeto. Los ataques recaen en gran medida sobre su funcionamiento mental y sobre su yo, de modo tal que este ve mermada su función representativa hasta el punto en que se diluye el universo de las formas y el propio yo. Por último, el sujeto encuentra una «solución» evacuando la tensión vital, con lo que aplaca el terror al precio de una muerte parcial y de un sentimiento de Vacío (AU)

The paper notes that there are two periods in the work of André Green, in which he arrives at his formulations on borderline patients. After characterizing the way in which they were thematized in the first period and making several references to subsequent modifications, the author focuses upon the role of the bad object in these patients and the various descriptions that Green has provided of the object and its attitude. It later compares and contrasts these variations in the attitude of the object with the distinct moments of the circuit of the patient’s desire to be. In this way, the author indicates that when this desire is not activated, the object appears to be taking on a structuring role. Upon being activated, the object becomes threatening, attacking and terrorizing the subject. The attacks fall largely on the subject’s mental functioning and ego, in such a way that the ego perceives its representative function undermined to the point where the universe of forms - and the ego itself -is dissolved. Ultimately, the subject finds a “solution” by evacuating the vital tension, with which it assuages the terror at the price of a partial death and a feeling of emptiness (AU)

Lo arcaico: reflexiones sobre los comienzos de la vida psíquica / The archaic: reflections on the beginning of psychic life and its impact upon the organization of personal life

Este trabajo revisa las alusiones de Freud a procesos psíquicos tempranos y su uso del término «arcaico» como sinónimo de filogenético. Examina la aparición del neologismo «lo arcaico» como nombre y presenta la etiología y manifestaciones de lo arcaico en la clínica psicoanalítica. Reconsidera la noción de representación proponiendo que debemos ón proponiendo que debemos postular una representación vivencial: una form afectiva de representarse a sí mismo con el otro en un escenario de encuentro relacional corporal ya sea integrado o fallido. Sugiere que la comunicación entre personas requiere la correspondencia intencional de sentimientos juntamente con mensajes complementarios, ya sean verbales o gestuales. Retomando las «pequeñas pulsiones» de Freud, propone restaurarles su valor psíquico como fundantes de la mente, del cuerpo erógeno y del deseo psíquico de vivir. Ofrece observaciones de investigadores de la primera infancia para fundamentar sus propuestas. Presenta ilustraciones clínicas de otros autores y la de su paciente D. J. Propone que conceptualicemos la «pulsión de muerte» como las consecuencias dinámicas y sintomáticas de haber perdido toda esperanza de comunicarse con otros como un sí mismo reconocido. Concluye con reflexiones técnicas para elaborar los procesos arcaicos durante el psicoanálisis (AU)

This paper examines Freud’s allusions to early psychic processes and his use of the term «archaic» as a synonym for phylogenetic. The author examines the appearance of the neologism «the archaic» and presents the aetiology and manifestations of the archaic in psychoanalytic clinical practice. The notion of representation is reconsidered, suggesting the advancement of an experiential representation: an effective way to represent oneself with the other in a scene of bodily relational encounter, whether integrated or failed. The author suggests that the communication between persons requires the intentional reciprocity of feelings together with complementary messages, be they verbal or gestural. Returning to Freud’s «little [ad hoc] instincts», the author proposes reinstating their psychic value as foundational to the mind, the erogenous body and the psychic desire to live. Observations by early Childhood researchers are provided to lay the foundations for the author’s proposals. Clinical illustrations of the author’s patient DJ. and those of other authors are presented. The author proposes that we conceptualize the «death drive» as the dynamic and symptomatic consequences of having lost all hope of communicating with others as a recognized self. The Work concludes With reflections on technique to work through the archaic processes during analysis (AU)

[Therapy for elderly family members and couples: concerning the viability of relationships in later life, the role reversal and 'finishing' amicably]. / Familie- en paartherapie bij ouderen: over leefbaarheid, rolomkering en finishing well.

BACKGROUND: Research shows that in most countries the number of elderly persons is increasing and that close relationships in late life are playing a more important role. Therefore, it is surprising that there have been so few publications about family therapy for the elderly. AIM: To formulate some guidelines for psychotherapy for family members in their later years and to make suggestions regarding further research. METHOD: We summarise the existing literature and focus on important themes about working with the elderly, supplementing major issues with our own clinical experience. RESULTS: Family therapy with the elderly differs from therapy for younger adults in some respects; for instance, the emphasis in the case of the elderly is more on strengthening the viability of a long/standing relationship. The reversal of roles that often accompanies the ageing process and leads to increasing dependency is another factor that affects the elderly more than the younger adults. If the last stage of life is to finish calmly and amicably, therapists need to tackle any tensions or injustices that patients have experienced in the course of their relationships. CONCLUSION: Psychotherapy for the elderly needs to provide clients with constant opportunities for reflection and should initiate discussions about partners' experiences of tensions and injustices in their earlier relationship. However, the increasing number of elderly persons means that more empirical research needs to be done into systematic psychotherapy.

The analyst's authenticity: "if you see something, say something".

The history of authenticity in psychoanalysis is as old as analysis itself, but the analyst's authenticity in particular has become an increasingly important area of focus in recent decades. This article traces the development of conceptions of analytic authenticity and proposes that the analyst's spontaneous verbalization of his or her unformulated experience in session can be a potent force in the course of an analysis. We acknowledge that although analytic authenticity can be a challenging ideal for the analyst to strive for, it contains the power to transform the experience of the patient and the analyst, as well as the meaning of their work together. Whether it comes in the form of an insight-oriented comment or a simple acknowledgment of things as they seem to be, a therapist's willingness to speak aloud something that has lost its language is a powerful clinical phenomenon that transcends theoretical orientation and modality.

"Spinning one's wheels": Nonimproved patients view their psychotherapy.

OBJECTIVE: To explore psychotherapy experiences among nonimproved young adults in psychoanalytic psychotherapy. METHOD: A two-stage, mixed-method design was used. Twenty patients in the clinical range at pretreatment were identified as either with reliable deterioration or with no reliable change at termination. Interviews at termination and 3-year follow-up were analyzed with grounded theory methodology. RESULTS: "Spinning One's Wheels" emerged as a core category. The patients described the therapeutic relationship as distanced and artificial. While they saw active components in therapy and their own activities in life as beneficial, therapy itself was experienced as overly focused on problem insight and past history. CONCLUSIONS: When the therapist does not contribute to the achievement of the patient's treatment goals--even when the patient gains some benefit--the patient does not fully profit from the therapy.

The twilight of the training analysis system.

This paper briefly reviews challenges to psychoanalysis at this time, including those derived from both external, societal origins and internal psychoanalytic problems. It focuses attention on serious conflicts around psychoanalytic education, and refers to the training analysis system as a central problem determining fundamental constraints on present-day psychoanalytic education. These constraints are examined in some detail, and the general advantages and disadvantages of the training analysis system are outlined. The effects of all these dynamics on the administrative organization of the American Psychoanalytic Association are explored, and a proposal for a fundamental reorganization of our educational system to resolve the correspondent problems is outlined.