Analytic listening and the analyst's self-analysis.

In recent decades analysts in North America have been writing about the challenge of listening to clinical material in ways which take account of the two person psychoanalytic situation. In that mutually regressive setting, self-analytic thinking on behalf of the analysand is essential for many analysts, because in it the analyst often relies on thoughts and feelings about conflicted and painful personal experience better to understand the analysand's inner experience. Effortful introspection allows some mastery, at least for the moment, of conflict which might otherwise prevent the analyst from thinking about and understanding what his inner experience may be telling him about his patient's mental life. In this essay the author describes the way an humiliating memory from his own childhood, recalled in response to his patient's dream, served as a cornerstone of his self-analytic effort on behalf of his patient. Coupled with self-analysis concerning his recent neck surgery, the analyst's self-reflections allowed him to be sensitive to a critical development in the analysis. This way of working complements the more traditional way analysts develop ideas from direct observation of the analysand in the consulting room.

The analyst's self-analysis and its impact on clinical work: a comment on the sources and importance of personal insights.

In reviewing descriptions of self-analysis in the literature, as part of an ongoing inquiry into the nature and role of self-analysis in the life and work of the psychoanalyst, the author noted a focus on circumscribed self-analytic work, or on a method for self-analysis that did not stress its clinical relevance. Missing were descriptions of the encompassing, multi-sourced, multimotivated, interminable nature of self-analysis in the analyst's work life and personal life. In response to those findings, the author focuses on the conduct of his self-analysis over a period of several months, following an illness experienced by his mother. He attempts to convey certain qualities of his self-analysis: it goes on all the time, it is variously fueled by experiences in and outside his consulting room, and it is practiced self-consciously and with self-discipline. He also describes the ways in which his self-analysis enhances his clinical effectiveness and promotes his personal growth, and notes that all of an analyst's experiences are interconnected opportunities for personal and professional development.

Introducing psychiatric residents to psychoanalysis: a visiting analyst's perspective.

The serious decline in applicants for psychoanalytic training mandates the attention of psychoanalytic educators. If students are to be drawn to psychoanalysis, creative methods must be employed to convey the vigor and excitement of work in the field. The author describes two experiences as a visiting analyst, in a university hospital psychiatric residency in which there is almost no regular exposure to psychoanalytic thinking. Because he was dissatisfied with an approach that stressed literature review and psychotherapy case presentations and supervision, he developed a teaching technique through which he was able to show the residents how he thought analytically and self-analytically. This teaching method is discussed in terms of Stein's (1988) injunction that analysts reveal more about the process of their thinking when they write, his description of how Bertram D. Lewin taught by encouraging analytic candidates to free-associate as a method of understanding new case material, and Arlow's (1972) view of the centrality of identification in education.

Victims of violence and post-traumatic stress disorder.

PTSD can occur in victims of violence. It is not known whether PTSD is caused by the psychological reaction of helplessness, shame, and guilt in the face of a traumatic stressor, whether there is some sort of fundamental psychobiologic change in the CNS in response to a stressor, or whether psychological reactions lead to biologic changes and both then coexist. PTSD after experiencing violence is characterized by re-experiencing phenomena, numbing or the avoidance of stimuli associated with the violent event, and symptoms of increased arousal. The disorder may begin immediately after the trauma or onset may be delayed for months or even years. Even after PTSD is resolved, it can return years later in response to an event that reminds the trauma victim of his earlier experience. Treatment consists of individual psychotherapy, family therapy, group therapy, and a range of pharmacotherapeutic interventions. Experimental therapies are being developed such as those that combine narcosynthesis and talking therapy, and descriptions of these appear in the literature. It is important for the psychiatrist attempting individual psychotherapy of a sufferer of PTSD for the first time to consider supervision with a colleague who possesses expertise in treating the disorder, for many treatment efforts fail because of countertransference reactions. Similarly, those who employ other forms of talking therapy will benefit from supervision.