Empty Heart Disease: Teaching and Learning in China.

Drawing on 15 years of experience teaching psychoanalytic theory and therapy primarily from an object relations perspective to Chinese psychotherapists onsite and online, the authors present their learning about Chinese culture, social history, and philosophy, and the Chinese way of communicating about emotional experience. Their essay is imbued with the Chinese use of metaphor and psychosomatic symbolization, particularly involving the heart. They elaborate on the Chinese concept of Empty Heart Disease, comparing and contrasting it to Western concepts from literature, sociology and psychoanalysis, namely spleen, anomie, dead mother, and schizoid, empty, false, and narcissistic self-states. They expand upon and extend the empty heart concept to various age groups and symptom presentations in China, illustrated by a vignette from individual psychoanalysis with a woman and three vignettes from applied psychoanalysis of a couple with no intimacy, a child with an obsessive psychosomatic symptom, and an adolescent school dropout who was self-harming and suicidal in response to academic pressure. Having emphasized the connection between symptom presentations and social life and times, they discuss the impact of trauma, its transgenerational transmission in China, and the impact of unprecedented economic growth and social change on individuals, couples and families.

Sure It Works in Practice, but Does It Work in Theory? Appreciating Fred Pine.

Fred Pine is a major contributor to contemporary Freudian analytic work. He expanded the breadth of clinical psychoanalysis by showing how the analyst could integrate ever expanding perspectives in analysis, and he expanded its depth through greater insight into how development affects psychic structure and, thereby, the context within which unconscious conflict and compromise is experienced and processed. Both of these-his expansion of potential variables implicated in the process of dynamic conflict and his developmental focus on structural deficit-have led to a way of Freudian thinking that is highly assimilative and integrative. Pine's focus on integrating disparate points of view-not different theories, but clinical observations that are featured in different overall theories-illuminates clinical possibility and nuance. Pine's work leads to questions about the relation of psychoanalytic theory to analytic practice and the definition of contemporary Freudian psychoanalysis itself.

Sandplay Therapy and Active Imagination: What Are the Similarities and Differences? Reflections about Jung's Writings on Active Imagination.

Jung stated that active imagination is a fundamental component of the second phase of an analysis that can continue even outside the analytic setting. Since it can be conveyed through various expressive techniques, such as writing, drawing, and painting, it is possible to argue that all forms of psychotherapy based on art (e.g., poetry, dance, and theater) originate from Jung's contribution about active imagination. This paper focuses on Sandplay Therapy as one of the forms of expression rooted in active imagination. Apart from some critical differences between the two analytic processes (e.g., active imagination is usually prompted in the last phase of the analysis, while Sandplay Therapy might be used since the first sessions), there are several convergences. Among the principal analogies, consciousness lends its expressive means to the unconscious, which decides what to depict. Also, the resulting image is determined from both the consciousness and the unconscious and is related to the person's conscious situation. Finally, I suggest that Sandplay Therapy-aside from contributing to the subsequent development of active imagination itself (as suggested by Dr. Carducci)-might also be used to practice active imagination in a "facilitated" and protected setting. It would help let the unconscious come up while creating the image in the sandtray, and it fosters the confrontation between the unconscious and the consciousness through the contemplation of the image in the sandtray.

Do we know our place? The role of psychoanalysis in public life.

The contributions to this Psychoanalytic Controversies section explore the question of what psychoanalysis may be able to contribute to thinking about some of the challenges currently confronting humanity and how such communications can be made effectively. This introduction to the section frames the debate with some reflections on anxieties that have been expressed about the application of psychoanalytic ideas beyond the clinical context, the risks of insularity, the need for appropriate humility, and the reality of the embeddedness of analytic practice, in particular social, cultural, and historical contexts. Contributions from Claudia Frank, Sudhir Kakar, Eli Zaretsky, Michael Rustin, Pratyusha Tummala-Narra, Magda Khouri, and Sally Weintrobe are introduced.

Psychoanalysis and the Experience of Homelessness.

Psychoanalysis is often viewed as a practice relevant only to educated people of means. This article describes a project that matches psychoanalytically trained clinicians with unhoused and formerly unhoused adults in a large urban community. D. W. Winnicott's ideas about impingement, the holding environment, fear of breakdown, and careful monitoring of the analyst's interiority have proven to be most valuable theoretical and clinical tools. A decade-long case example demonstrates the challenges and healing potentials of the work.

Freud in Bulgaria: Psychoanalysis, Literature, Translation: An Experience with the Singular.

This contribution considers a monthly seminar, Literature and Psychoanalysis, that has been taking place at Sofia University (Sofia, Bulgaria) since 2017. Three of the seminar's founders reflect on the transferences between literature and psychoanalysis, and on the ways in which literature and psychoanalysis can meaningfully converse. The exchange also touches on the fate of Freud's textual legacy in communist and post-communist Bulgaria.

Tran in April: The Analysis of A Transgender Adolescent With Notes on the Metapsychology of Gender Transition.

The aim of this article is twofold: firstly, to describe the seven-year analytic treatment of a TG adolescent (F "April" to M "Tran") and, secondly, based on the clinical observations, to propose a reflection on the intrapsychic events linked to gender transition. We could witness during this analysis that the dissonant anatomical sex, which is at the heart of the gender dysphoria, resists mentalization and consequently its psychological integration. The psychic events of transition, understood here on the model of a mourning process, could denote the various strategies necessary to the TG individual to negotiate the obstacle of mentalization.

Hearts and minds: The technopolitical role of affect in sociotechnical imaginaries.

Sociotechnical imaginaries (SIs) have emerged as a popular and generative concept within Science and Technology Studies (STS). This article draws out the affective component of SIs, combining a review of relevant literatures with an empirical case study of an anti-fracking imaginary in Ireland to suggest how we might theorize an affective technopolitics of SIs. The literature review identifies three key aspects of SIs that would benefit from a more coherent conceptualization of affect: the utopian, productive, and collectivizing dimensions of imaginaries. Emotions such as desire and fear appear prominently in the SI literature, but in ways that require development. Using empirical examples from my research, I outline what this developed understanding of emotions in imaginaries might look like. I examine the role that emotions played in the development and settlement of an anti-fracking imaginary in Ireland, highlighting how the intensive, multimodal, and dynamic nature of affect underpinned the productive, collective, and utopian dimensions of the SI. I conclude with some remarks about how this developed theory of emotion positions STS researchers to address issues of humanity, representation, and the building of better worlds.

RELATIONAL DIMENSION VERSUS ARTIFICIAL INTELLIGENCE.

Thirty years ago, we proposed the similarity between the functioning of artificial intelligence and the human psyche, suggesting multiple parallels between the Freudian model proposed in the "Project for Psychology for Neurologists" and the connectionist theories applied in the generation of parallel distributed processing systems (PDP), also known as connectionist models. These models have been and continue to be the foundation of general artificial intelligences like ChatGPT, evolving and gaining prominence in everyday life. From the earliest applications in psychiatry, recreating computationally simulated modes of illnesses, to the use of deep learning models, especially in the field of computer vision for tasks such as image recognition, segmentation, and classification. Recurrent Neural Networks (RNN) and Long Short-Term Memory (LSTM) are employed for tasks involving sequences of data, such as natural language processing, or models based on the Transformer architecture, like BERT and GPT (Generative Pre-trained Transformer), which have revolutionized natural language processing. In this present work, we analyze the significance of the emergence and exponential growth of these types of tools in the field of healthcare, from medical diagnosis and patient care to psychological attention and psychotherapeutic treatment, exploring the changes and transformations in the forms of subjective expression that are arising. We also examine and argue for the importance and validity of the relational dimension proposed by our psychoanalytic approach in contrast to the potential use of these tools as treatment models.

When psychoanalytic dyads are forced into the virtual world.

The Covid pandemic changed the daily routines for millions of people. This was the case for those who were gainfully employed, especially for those who work as psychoanalysts and psychodynamic psychotherapists. At least for a good while, the practice of psychotherapy and psychoanalysis moved from the consulting room to the virtual world of the internet. The author explores the impact virtual therapy had on three different patients. One began a three time a week analysis during the pandemic. The duo met virtually for a year and a half before their first in person meeting. The other two patients had begun twice a week analyses a few years before the pandemic, met virtually for two years, until in person sessions restarted. The patients and the author describe their experiences.

The elephant in the zoom: will psychoanalysis survive the screen?

While screen-mediated analysis long predated the pandemic, it was largely seen as non-equivalent to in-person treatment by analysts and patients alike. When COVID forced us to move our entire practices to the screen, our concerns about its limitations were replaced by relief; we could continue doing analytic work during a terrifying and challenging time. Three years later, many have chosen to continue practicing remotely for reasons that are no longer driven by fears of exposure. We mostly minimize or deny our earlier concerns about the limitations of screen work. Have we chosen convenience, ease, and a personal sense of safety over togetherness, while ignoring the underbelly of remote work? This paper identifies the convergence of several forces underlying our decision to stay remote, including guilt and anxiety about privileging our own self-interest, unmourned losses and collective PTSD, fear of the future and existential anxiety about living in a techno-culture that threatens to replace us. Our denial of these powerful forces makes it easy to rationalize a decision to embrace remote work and disavow the threat it poses to our field.

The Wisdom of Shadows: Chaos, Disintegration, and Psychic Growth in King Lear.

King Lear is a timeless exposition of humankind's attempt to find meaning amidst the ceaseless turbulence of existence. This entails navigating the disintegrating pulls of nature and harmful human action that exist alongside affiliative, life-promoting gestures shown toward one another. As the predictability and safety afforded by social and two-dimensional psychic constructs collapse, several characters in this play are forced to reckon with the untamed, less organized realms of the mind and natural world. This leads to movements toward psychic paralysis and disintegration, as well as toward growth and interpersonal healing, dynamics that hinge on the characters' internal structuring.

Property, Materiality, Proximity: The Analytic Frame and In-Person Work.

In-person meeting offers psychologically usable material-signifiers that serve as day's residue-that cannot be duplicated or substituted for in remote ways of working. Questions of materiality, the history and specificity of location, and bodily proximity all are key aspects of the psychoanalytic frame, as Bleger's classic formulations attest. The COVID-19 pandemic has changed the choreography of engagement between analyst and patient: the ghostly dust in the frame enters the room. As Bleger says, with ghosts so rustled, nonprocess has a chance to become process. Two clinical examples highlight these points about materiality and in-person working. The final section of the paper extends Bleger's description to tackle the perplexing situation of patients who hesitate to return to the office. Issues of "ghosting," vanishing, disappearing are discussed, and linked to the constitutive absence that grounds any meaningfully structured presence. This constitutive absence is evoked by the prospect of the return to in-person analytic work. A final clinical example is used to illustrate this disturbing and irreducible fact about human interaction when two bodies are together in a room to discuss, over time, the life of one of the participants.

BACK TO THE FUTURE WITH SENECA'S PRACTICAL PHILOSOPHY IN MIND.

This paper regards Seneca's practical philosophy as ancestor to psychoanalytically informed psychotherapy and as a progenitor of ongoing contemporary praxis in applied ideas of mind. Facing forward into the Anthropocene, as psychoanalysis encounters Artificial Intelligence, the convergence with contemporary psychoanalytic psychotherapy of value concepts developed from Antiquity is discussed. Drawn from Seneca's Letters on Ethics, constellations of significant ideas present in ancient practical philosophy resonate with similar configurations developed two millennia later, and central to the practice of contemporary psychotherapy.

FROM THE GATE TO THE GATEWAY: PSYCHOANALYTIC NAVIGATIONS ONLINE.

The shift towards remote or online therapy was compelled by the Pandemic. Many colleagues, who neither had practice using this modality, nor had ever considered it as a possibility, ultimately adopted it. This experience brought with it a substantial expansion of online therapy beyond that moment of emergency. It opened up new prospects of intervention, but at the same time it required a greater measure of reflection in order to understand how to inhabit this new therapy space. Setting aside provisory, intermittent, or emergency situations, which temporarily transfer therapy into a "field of tents" (Bolognini, 2021), the author proposes to consider how online psychotherapy redefines an important element of the psychoanalytic setting-the issue of the space. This is no longer the therapist's place of work, envisaged and organized by him/her/them, fixed in time, and contrived only to welcome the therapeutic relationship-one of the crucial aspects of the external setting, which together with the temporal dimension, fulfills the therapy ritual. Assuming the framework to be essential to the psychoanalytic process, this paper will focus on the methodology of online therapy. The author will describe the contributions of the neurosciences, to provide a deeper understanding of the distinctive characteristics of sharing in an online vs. an offline space. Online therapy should be assessed for its distinguishing qualities within a complete theoretical, technical, and clinical reflection specific to each case. Proceeding as if it were a mere relocation of an in-person analysis would enhance the seductiveness of a therapy that is easily accessible with any laptop anywhere, anytime, and in which one could mistake an online connection for a deep connection.

The Artificial Third: A Broad View of the Effects of Introducing Generative Artificial Intelligence on Psychotherapy.

Unlabelled: This paper explores a significant shift in the field of mental health in general and psychotherapy in particular following generative artificial intelligence's new capabilities in processing and generating humanlike language. Following Freud, this lingo-technological development is conceptualized as the "fourth narcissistic blow" that science inflicts on humanity. We argue that this narcissistic blow has a potentially dramatic influence on perceptions of human society, interrelationships, and the self. We should, accordingly, expect dramatic changes in perceptions of the therapeutic act following the emergence of what we term the artificial third in the field of psychotherapy. The introduction of an artificial third marks a critical juncture, prompting us to ask the following important core questions that address two basic elements of critical thinking, namely, transparency and autonomy: (1) What is this new artificial presence in therapy relationships? (2) How does it reshape our perception of ourselves and our interpersonal dynamics? and (3) What remains of the irreplaceable human elements at the core of therapy? Given the ethical implications that arise from these questions, this paper proposes that the artificial third can be a valuable asset when applied with insight and ethical consideration, enhancing but not replacing the human touch in therapy.

The Operators Model of Psychoanalytic Clinical Reasoning.

In this paper, the authors develop a model of psychoanalytic clinical reasoning as the inferential process by which analytic therapists are able to arrive at an understanding of the clinical material. Starting from Bion's theory of functions, the authors propose that a "function" can be thought of as a condition-action sequence that analytic therapists implicitly use to respond to certain configurations of elements in the material by executing conceptual or reflective operations. To investigate the main families of functions that are used by analytic therapists in everyday practice, the authors used an interpersonal process recall procedure based on supervision sessions from a theoretically heterogeneous group of participants. A consensual procedure was developed to identify operations, spell out the underlying functions, and group functions into families. Twelve families of functions were identified that appear to be used by analytic therapists regardless of their schools of thought. The authors call them the "operators" of psychoanalytic clinical reasoning. According to the operators model, the process of psychoanalytic clinical reasoning consists in the chaining together of operations using functions from different families. A specific collection of "clinical reasoning styles" seems to be interwoven in this process. Different avenues open up for research, clinical practice, and training.

The Columbia Academy for Psychoanalytic Educators: A Pilot Program for Developing Analysts and Supervisors of Analytic Candidates.

The Columbia Academy for Psychoanalytic Educators supports graduate analysts' professional development at the Columbia University Center for Psychoanalytic Training and Research. In 2018, a pilot program was launched for faculty interested in analyzing and supervising candidates, whose aim is to support and educate those interested in taking on these essential training functions. The focus is on educating the educators, which is a significant departure from the historical focus on evaluation, vetting, and faculty hierarchies. In the process of developing and piloting the program, complex and long debated issues in psychoanalytic education and development were considered that are relevant to many institutes, including training of supervisors and analysts of candidates, addressing problematic faculty hierarchies, creating safety for those presenting clinical work to colleagues, building professional peer relationships, and engagement of faculty in time consuming and nonremunerative activities. The authors report on their experience developing and evaluating this pilot program.

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.

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.