Early transferences and transference-like reactions.

Some patients manifest intense transferences or transference-like reactions in the earliest hours of psychotherapy. Although these reactions may actually represent transference, they may also arise from other sources, such as aspects of a patient's character, displacements from former therapists, impaired reality testing, information about the therapist, and therapist's behavior. Clinical examples are presented, and their management is discussed.

Freud's "narcissism of minor differences": a review and reassessment.

Freud coined the name and briefly described the narcissism of minor differences. Although he initially regarded it as a form of individual behavior, he later came to see its implications for groups. This paper explores the manifestations of the narcissism of minor differences in psychoanalytic organizations and treatment. In contrast to Freud's observation that the narcissism of minor differences is relatively harmless, I suggest that in the social sphere it harbors the potential for a pernicious escalation into hostile and destructive actions on a widespread scale.

On the nature of the oceanic experience.

It is postulated that consciousness is not simply an organ of perception, but that it possesses a structure, or organization, despite its enormous fluidity. In support of these views, the oceanic experience is explored. It demonstrates the impact, on this state of consciousness, of the subject's values and culture. Like the oceanic experience, every state of consciousness--what is in awareness at any given time--is a complex phenomenon that derives from all aspects of the psyche, including the subject's value system and the influences of his culture.

The sex of the psychotherapist.

The authors note the recent controversy about whether the sex of the psychotherapist is an important factor in the treatment of patients with certain neurotic and personality disturbances and suggest that much of the confusion is because supportive and insight-oriented psychotherapy are not clearly distinguished. After reviewing the relevant literature they present five clinical vignettes which suggest that the sex of the therapist is immaterial in insight-oriented psychotherapy and that attention to defenses, transference, and resistance remains the cornerstone of successful psychotherapy.

Origins of the fear of success.

Although neurotic conflicts relating to achievement and success are common among patients in psychoanalysis, the psychoanalytic literature is remarkably limited and tends to portray conflict relating to success only in terms of oedipal conflict. Through four clinical vignettes of patients in psychoanalysis, the authors demonstrate that the fear of success is an overdetermined final common pathway for conflicts at any of several developmental levels.

Effects of family constellation and dynamics on the form of the Oedipus complex.

The Oedipus complex take its particular form from a variety of sources--biological and environmental. This paper focuses on the role of the family constellation in imparting a specific form to this schemata, here described as a double Oedipus complex. Some of the relevant psychoanalytic literature is reviewed. It is suggested that such a configuration of the Oedipus complex may not in itself lead to a pathologic outcome. In the case history presented, specific characteristics of the patient's family are presumed to have been pathogenetic leading to the inadequate resolution of his Oedipus complex. Relevant aspects of the analytic process are discussed, in particular, the vicissitudes of the transferences. It is concluded that the schemata of the Oedipus complex is significantly modified by external circumstances, in this case by a special family constellation and its dynamics.

Chance, ambiguity, and psychological mindedness.

The inability to believe in chance occurrences and an intolerance of ambiguity in the external world are often the outward manifestations of poor psychological mindedness. Such attitudes are frequently accompanied by beliefs in the occult and the mystical. It is suggested that these factors be considered when an individual is being evaluated for analytic treatment.

The use of dreams in psychotherapy: practical guidelines.

Although there is a large literature pertaining to the use of the dream in psychoanalysis, there is no systematic approach to working with dreams in psychotherapy. This communication seeks to present some guidelines for the use of the dream in psychotherapy. Reference is made to the significant difference in the "dimensions" of psychoanalysis as compared to psychotherapy. A distinction is drawn between the use of the dream in supportive psychotherapy as contrasted with insight-oriented psychotherapy. In the former, the dream--if used at all--serves supportive functions; in the latter, the goals are to develop better awareness by the patient of himself. Understanding of the dream is reached by inserting it into the context of the patient's psychological life; however, what is actually communicated to the patient will be keyed to the psychologic surface that the patient presents.

Normal and pathological nostalgia.

Nostalgia is distinguished from homesickness from which it was originally derived, and from fantasy to which it is related. It is described as an affective-cognitive experience, usually involving memories of places in one's past. These memories are associated with a characteristic affective coloration described as "bittersweet". It is concluded that the locales remembered are displacements from objects whose representation was repressed. Nostalgia is a ubiquitous human experience that is evoked by particular stimuli under special circumstances and, while it is generally a normal occurrence, pathological forms occur. Among those discussed are: nostalgia as a substitute for mourning, as an attempted mastery through idealization and displacement of a painful past, as a resistance in analysis, and as a counterphobic mechanism. Nostalgia not only serves as a screen memory, but may also be said to operate as a screen affect.

On the occurrence of incest fantasies.

Incest fantasies are often regarded as suggesting important ego or superego deficits. Actually, some nonpsychotic patients are found to experience such fantasies. In these cases the phenomenon occurs when certain psychogenetic and psychodynamic factors are present.

Survey of psychiatric treatment effectiveness in a medical student clinic.

Eighty patients, from four university-based psychiatric outpatient departments, were seen for four to six weeks by medical students. Eighty-two percent of the patients reported "some" to "marked" improvement. The four groups were studied to determine significant variables. A mutually positive attitude between patient and therapist appeared to be the only significant factor.