ABSTRACT
In the search for ever earlier determinants of adult pathology many ignore the transformative impact of adolescence. The authors suggest that the reality of adolescent development creates a vulnerability to being overwhelmed. Through deferred action childhood experiences may interact with adolescent realities and omnipotent beliefs to traumatize the adolescent. The authors suggest that trauma in adolescence can be independent both of the intensity of current external exposure or of earlier traumatic experiences.
Subject(s)
Adolescent Behavior/psychology , Stress Disorders, Post-Traumatic/psychology , Adolescent , Female , Freudian Theory , Humans , Male , Psychoanalytic InterpretationABSTRACT
Volumes have been written about the patient's love for the therapist, but there has been relatively little discussion of the therapist's love for the patient. In an attempt to create a theoretical and technical space for discussing the appropriateness and role of love in the therapeutic relationship, a revised concept of the therapeutic alliance is applied to provide technical guidelines and understanding of two kinds of love between patient and therapist, corresponding to two systems of self-esteem regulation: an open, reality-oriented system and a closed, sadomasochistic system organized according to omnipotent beliefs. Examples of the role of love through the phases of treatment illustrate the interrelationship of love and the accomplishment of therapeutic alliance tasks.
Subject(s)
Love , Professional-Patient Relations , Psychoanalytic Therapy , Adult , Countertransference , Defense Mechanisms , Female , Humans , Male , Masochism , Middle Aged , Psychoanalytic Theory , Reality Testing , Sadism , Self ConceptABSTRACT
This paper traces the history of the therapeutic alliance concept, examining how it has been used and misused, at times elevated to a central position and at others rejected altogether. The loss of this concept created a vacuum in classical psychoanalysis that has been filled by rival theories. The continuing usefulness of looking at the treatment process through the lens of the therapeutic alliance, particularly in relation to the manifold difficulties of working with sadomasochistic pathology, is suggested. To this end, revisions of the theory of the therapeutic alliance are suggested to address some of the difficulties that have arisen in conceptualizing this aspect of the therapeutic relationship, and to provide an integrated dynamic model for working with patients at each phase of treatment. This revised model acknowledges the complexity of the domain and encompasses the multiple tasks, functions, partners, and treatment phases involved. The utility of the revised theory is illustrated in application to understanding the sadomasochistic, omnipotent resistances of a female patient through the phases of her analysis.
Subject(s)
Masochism/psychology , Physician-Patient Relations , Psychoanalytic Therapy , Sadism/psychology , Adult , Defense Mechanisms , Fantasy , Female , Humans , Male , Psychoanalytic TheoryABSTRACT
There is a tendency in psychoanalysis to seek ever earlier determinants of pathology. One effect of this search is to relegate adult memories of latency and adolescence to serving mainly a defensive screen function. Psychoanalytic material from child and adolescent cases is used in this paper to illuminate postoedipal developmental transformations. These findings are applied to the understanding and technique of work with adults. Alertness to latency elements can affect the timing of interpretations, the understanding of neurosogenic factors, and the forces for health available in the patient's personality. Alertness to adolescent phenomena highlights the adult patient's difficulty in integrating adolescent realities with childhood fantasy solutions to preoedipal and oedipal conflicts. We conclude that no one phase has preeminence over others, that earlier is not necessarily more important, and that there cannot be pure recapitulation, revival, or "reanimation" (Freud, 1925) of the past in the present. However, knowledge of the transformations appropriate to each phase in the past gives us additional access to the determinants and functions of the patient's pathology in the present, increases the specificity of genetic interpretation, and gives both patient and analyst greater conviction about the accuracy of the essential analytic work of reconstruction.
Subject(s)
Latency Period, Psychological , Psychoanalytic Theory , Psychoanalytic Therapy , Psychology, Adolescent , Adult , Aging/psychology , Anxiety, Separation/psychology , Anxiety, Separation/therapy , Child , Female , Humans , Male , Neurotic Disorders/etiology , Neurotic Disorders/psychology , Neurotic Disorders/therapy , Oedipus Complex , SuperegoABSTRACT
This paper explores the relation of the delusion of omnipotence to masochism and suggests that this fantasy constitutes a major component of the resistance so prominent in work with masochistic patients. The connections among masochism, omnipotence, negative therapeutic reaction, and clinging to pain are discussed. The classical view has been that the failure of infantile omnipotence forces the child to turn to reality. Our experience with masochistic patients suggests that it is the real failure to achieve competent interactions with others that forces the child to turn to omnipotent solutions. The distinction is made between fantasies that enhance the real capacities of the self and those aimed at denying and transforming the pain and inadequacy of the mother-child relationship. The epigenetic transformations of omnipotent fantasies through all levels of development are described. The patient's need to protect the omnipotent fantasy is discussed in relation to resistance at each phase of analysis.
Subject(s)
Defense Mechanisms , Delusions/psychology , Masochism/psychology , Personality Development , Psychoanalytic Theory , Psychoanalytic Therapy/methods , Fantasy , Freudian Theory , Humans , Mother-Child Relations , Neurotic Disorders/psychology , Physician-Patient Relations , Psychoanalytic InterpretationABSTRACT
In this paper the developmental hypothesis is presented that verbalization is a crucial element in integration and differentiation of the self. Material from four patients is used to illustrate paraverbal manifestations of psychophysiological distress in the transference-counter-transference relationship at moments of separation. These led to the reconstruction of a line of pathological development which was initiated in these patients by experiences of helplessness and rage at a time when affects and sensations were not clearly differentiated and no words were attached to them to integrate the body ego into the ego and self. Retrieval and gathering-in of these experiences to the ego took place initially through the analyst's perception of signal states of tension and confusion, which became part of the construction of the image of the patient as a toddler, and then led to verbalization of the affects and sensations involved.
