Transformation and Interpretation: The Case of Adam, A Clinical Narrative and Discussion.

This paper demonstrates how the Three-Level Model for Observing Transformations in Psychoanalysis permits a lively discussion among analysts on change and absence of change in the patient. The authors debate the nature and degree of the difficulties and explore conceptual questions and theoretical ideas to shed further light on change and mechanisms of change in the case of Adam.

The otherness of sexuality: Exploring the conflicted nature of drive, desire and object choice.

This article explores how the psychoanalytic drive theories of Freud, Laplanche and Lacan elucidate the conflicted nature of desire and object choice. In a close reading of Freud's Three Essays on the Theory of Sexuality (1905), I emphasize the inherent tension in Freud's thinking between the non-object-relatedness and object-relatedness of drive, as well as the conflictual path of object choice. Through discussion of Laplanche's theory of the origin and nature of the drive, I underline the significance of the unconscious, enigmatic messages of the object. I argue that Freud, Laplanche and Lacan, although in different ways, convey an idea of sexuality's otherness. This otherness may contribute to highlight divisions in the sphere of love, e.g. splits between sexuality and attachment so often encountered in clinical practice, when erotic desire comes into conflict with the need for a safe and stable relationship. The article aims at explicating the clinical value of a listening perspective entrenched in drive theory for understanding the ambivalence, conflicts and paradoxes of human object choice.

Analytic change: Assessing ways of being in a psychoanalytic follow-up interview.

The article argues that the concepts of relational scenario, structuralized affect and actualized affect are proposed candidates for observation of changes in relational ways of being as it is expressed in transference. A psychoanalytic follow-up interview of a former analytic patient is presented in order to illustrate how change in relational ways of being may be registered and studied. By triangulating the patient's verbal report of change with nonverbal information and transference-countertransference dynamics, one may grasp qualitative changes in relational ways of being. The case presented illustrates a former patient's on-going process of working towards representing aggression in a more direct manner and how this process is made observable with the aid of the proposed concepts in the interview situation. The proposed concepts of relational scenario, structuralized and actualized affect discussed are compared to the concept of transference used in studies of core conflictual relationship theme (CCRT).

Who is 'who' in dissociation?: A plea for psychodynamics in a time of trauma.

Contemporary theories of dissociation and trauma for the most part have evolved outside of psychoanalysis. Psychoanalytic writings have also been regarded as being in opposition to trauma-based notions of human psychopathology. The specific psychoanalytic contribution--the emphasis on unconscious conflict and meaning--is for the most part excluded from the discourse on dissociation, often resulting in a 'mechanic' conceptualisation of trauma. In this paper, based on clinical material, the author argues in favour of including conflict, unconscious intention and personal meaning in understanding the kind of dissociation we see in cases of multiple personality pathology. Textual analysis of letters written to the analyst illustrates how events of abuse are defensively elaborated. The author demonstrates that patterns of affect regulation and dominant object-relational strategies can be captured through analysis of the discourse structure. She focuses on how an organised character pattern, revealed mainly through narrative style and the analyst's countertransference, serves protective purposes as well as wish-fulfillment. She argues that dissociation in the form of multiple personalities may imply an active, strategic agent.

The Adult Attachment Interview and psychoanalytic outcome studies.

During the last two decades, the Adult Attachment Interview (AAI) has attracted growing interest from psychoanalysts concerned with empirical research. The paper discusses the application of Crittenden's Dynamic-Maturational AAI method for assessing the outcome of psychoanalysis. The aim is to demonstrate, through a case presentation, how therapeutic change can be expressed in the AAI. The pre- and post-treatment interviews of one patient, having completed a four-times-a-week psychoanalysis, are presented. It is demonstrated that the detailed discourse analysis of the AAI, based on transcribed tape-recorded interviews, focuses subtle formal elements of language and speech reflecting dominant patterns of affect regulation and object relating. The AAI text analysis provides possibility for coding procedural memory as conveyed by the handling of the relationship to the interviewer, incorporating the dynamic relationship between researcher and subject and thus complying with a methodological prerequisite regarded by many psychoanalysts as necessary for capturing data that are relevant to psychoanalysis. On this background, the method emerges as promising for psychoanalytic outcome studies.