Freud's treatment of a narcissistic patient.

The newly-published correspondence between Freud and Ernest Jones reveals Freud's views on the treatment of a severely narcissistic patient in 1922, just prior to his writing 'The Ego and the Id'. His formulation centres on 'a deep sense of guilt ... a conflict between Ego and Ideal ... whenever it is revived she projects her self-criticism to other people, turns her pangs of conscience into sadistic behaviour'. He aims toward 'reconciliation of her Ideal to her Ego', and emphasises her need for his friendly support in order to tolerate the analytic process. Freud's views, expressed in his formulation, coincide with ideas that the author has put forward over the past two decades in regard to the vicious cycle of punitive unconscious self-criticism, self-deprivation, and excessive demand (narcissistic entitlement) and the need to maintain functional neutrality by providing support. The discussion addresses the contrast between Freud's therapeutic activity and his published recommendations, emphasising Freud's mistaken belief in the analyst's 'objectivity' in the analytic situation and his passionate commitment to maintaining the scientific respectability of psychoanalysis, with its consequences in the minimalist austerity of 'classical technique'.

Helping patients by analyzing self-criticism.

This paper is addressed to patients' need for help with punitive self-critical attitudes. Such help has not always been sufficiently provided by psychoanalysts, owing to an unrecognized failure of neutrality. Historically, a gradual overemphasis on the concept of an unconscious sense of guilt has acted as a barrier to the appreciation of shame. An alternative concept, punitive unconscious self-criticism, which stands in contrast to constructive self-criticism and is common to the painful affects of guilt, shame, humiliation, and depression, can facilitate helpful analytic treatment. Heinz Kohut's contributions are examined. His analytic stance is differentiated from his theories of development. In the former, characterized by an affirmative attitude, he takes a position of functional neutrality toward shame and pays consistent though unstated attention to the effects of punitive unconscious self-criticism. The affirmative attitude can be employed without adoption of Kohut's self psychology, i.e., without abandoning the basic psychoanalytic approach to mental conflict and development. The concept of punitive unconscious self-criticism and the concept of divergent conflict, provide sufficient explanatory power. Clinical examples are used to illustrate these ideas.

The analyst's stance and the method of free association.

The concept of the analyst's stance is employed to organize a number of ideas about psychoanalytic work, past and present, especially from the viewpoint of the method of free association. Beginning with an emphasis on the intrinsic uncertainties and paradoxes of the analytic process, the author reviews the importance of words, the aim of mastering resistances (i.e., promoting freedom of association), and functional neutrality on the analyst's part. The problem of anonymity is considered from a number of angles. Two traditions of transference are described, deriving from Freud's overlapping early formulations. The distinction between old and new determinants in the two kinds of transference is useful and important in the analyst's stance. Attitudes toward insight, resistance, and conflict resolution are considered from the perspective of the distinction between divergent and convergent conflicts, with special emphasis on the role of punitive, unconscious self-criticism.

Some clinical applications of the distinction between divergent and convergent conflicts.

The concept of two kinds of mental conflicts, convergent and divergent, is applied to an important aspect of the therapeutic action of psychoanalysis: the way in which the relationship between pre-oedipal and oedipal components of neurosis is dealt with. The concepts of convergent and divergent conflicts and their relationship to an operational formulation of the psychoanalytic procedure, the method of free association, are presented briefly. The two-conflict model obviates the need either to abandon the concept of conflict or to assign an early developmental origin prematurely to some of the patient's problems. Awareness of the two kinds of conflicts, with their different forms of opposition, resistances, patterns of resolution, and kinds of insight, permits the analyst to maintain a consistent focus on interpretation and mastery of resistance as the first aim of analytic work. These concepts are illustrated in an extensive case example from an analysis. A consideration of manifest bisexuality and its analytic treatment as an example of an additional kind of clinical situation--problems of choice--concludes the paper.

Resistance in convergent and in divergent conflicts.

Psychoanalytic theory has limited the term conflict to refer only to convergent conflict, whose elements tend to move toward each other, as in repression. Formulations made from the viewpoint of the method of free association have led the author to favor an expansion in the concept of conflict to include also divergent conflict, whose elements tend to move apart, as in regression-progression and in mourning. A broad range of clinical and theoretical phenomena of psychoanalysis can be accounted for by such a revision in the concept of conflict. Focusing on resistance, this paper provides a historical review and discusses the application of an expanded concept of conflict in the field of psychoanalytic technique.

The analyst's conceptual freedom in the method of free association.

Anna Freud's observation of the loss entailed in the progress from the topographical to the structural theory is taken as the starting point of a discussion of the relationship between psychoanalytic theory and the psychoanalytic method. The discussion considers the dangers of misapplying theories in he clinical situation and the disadvantages of defining the method and aims of psychoanalytic treatment and investigation in theoretical terms. A focus on free association, with systematic initial formulation based on an operational rather than a theoretical framework, preserves the analyst's conceptual freedom while it permits further articulation with the wide range of psychoanalytic theoretical propositions. The problem of theoretical bias on the analyst's part can be lessened or even solved by moving with restraint from the associations to the formulations rather than in the opposite direction and by systematic attention to the sequences and patterns of the associations.