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This brief essay focuses on Adrienne Harris's consideration of the analyst's vocation, both as work and as a calling. Harris identifies a psychoanalytic vocation as one that is "unsettled," leaving analysts to examine countertransference by attending not only to their own affect states, but through the exhumation of generational transfers that are informed by social histories and constructions. Harris's generative pedagogy, rooted in her capacious comparative scholarship, stands as exemplary of the analytic vocation. [ABSTRACT FROM AUTHOR]

This paper was developed as part of a panel for the International Psychoanalytic Association's (IPA) 53rd Congress in July 2023. In this paper I discuss treatment with students from the American University of Afghanistan as part of a team at New York University's Postdoctoral Program in Psychoanalysis and Psychotherapy. The paper reviews the themes that I identified while working with three students from the university. The themes include issues of identity and power, role confusion, and finally the question "am I doing a good thing?" Simultaneously, I discuss my own countertransferential process and disavowed material based on my own cultural background. [ABSTRACT FROM AUTHOR]

This is a reply to the discussions by Arthur Fox, Megan Rundel, and Jeffrey Guss. Clarification is made on the utility of diagnosis, as well as further elaboration on what is common to both psychedelic states and the altered states of consciousness encountered in deep psychoanalytic work. Additional thoughts on the integration of a relational multiple self-state model with psychedelic therapy are provided. The importance of updating our psychoanalytic models as new science emerges is emphasized. The intersection of the analyst's belief system and its impact on countertransference is discussed. Differentiating the impact of the analyst's influence from the patient's openness to revelatory experience is addressed. Burton also responds to discussants on the subjects of ego dissolution, the presence/absence of conscience, defining mystical experience, Seth's childhood/family experience, and defining set and setting. [ABSTRACT FROM AUTHOR]

Psychopathy has long been considered untreatable. The purpose of this paper is to provide a report from the field on therapeutic gains made in the case of a psychopathic personality and to outline what appear to be the most effective aspects of the treatment, as well as to help integrate current psychedelic research and theory with psychoanalytic theory. These therapeutic factors include: tactful acknowledgment and confrontation of the patient's behavior and the disclosure to him of the diagnosis of psychopathy; a focus on his resentment toward existence itself; the cultivation of a relationship between the patient and his future self through the engagement of his imagination using mental time travel; the patient's psilocybin-induced mystical experience which occurred several months into treatment; and finally, the impact of the analyst's spiritual work that shaped the countertransference. The patient made dramatic improvements subsequent to his mystical experience, and was able to make use of the psychoanalytic work done during the "pre-mystical experience" period of his treatment. This case is an addition to the accumulating evidence for the efficacy of psychedelic-induced mystical experiences, and provides guidance on the provision of psychoanalytic treatment prior to treatment with psychedelic medication. [ABSTRACT FROM AUTHOR]

In this paper, I explore how patients' experiences of their analysts' physicality – conveyed in the concrete aspects of the analyst's body, clothing, and office – can be a constructive domain of budding intersubjective engagement. This is both generally true, and of specific salience with narcissistically vulnerable patients, for whom states of psychosomatic unity are compromised, and with whom finding ways to be "usable" as objects can be elusive. At the same time, both members of the dyad can resist such inquiries and enactments despite their generative potential. I highlight how we analysts may shy away from pursuing these aspects of our patients' transferences because of our own anxieties about how we do or do not want to be seen. Such anxieties and vulnerabilities can be heightened in this arena, given that the analyst's physicality reflects both material constraints and fluid, unstable meanings derived from the shifting intersections between personal construction, relational context, and the broader sociocultural surround, particularly as it informs expressions of gender, race, class, and the like. [ABSTRACT FROM AUTHOR]

This discussion explores an ambitiously conceived paper by Giuseppe Civitarese and Chiara Berrini (this issue, 2022) as it attempts to shed light on Bion's use of mathematical concepts—point and line—to better understand the process of symbolization and of desymbolization (e.g., attacks on linking) applied to the clinical situation. Employing the authors' elaboration of Bion's thesis that all psychical transformations occur and thinking develops (or fails to develop) within an analytic field marked by emotional experience, I show how this formulation is as relevant to reading a psychoanalytic text as it is to our work in the consulting room. Accordingly, my commentary focuses on how the authors' theoretical argument and clinical vignette impacted me, which I liken to "possibility clouds" arising in the analytic field. I suggest that such an approach echoes the authors' openness to "an extraordinary sequence of play" between analyst and patient that inspired their submission to this journal. [ABSTRACT FROM AUTHOR]

Interpretation and insight are a valuable asset in the treatment, but not enough to generate change. Mutative change depends on the analyst's being in the relation, rather than on his purposive doing. "Coasting" is when the process seems to flow easily and pleasantly, but nothing happens. The analyst is partly aware of it but does not act. This is solved when a new situation emerges unbidden in either or both parties. Relational freedom and therapeutic action are not chosen but emerge unexpectedly from the field and change it. Such non-causal approach is unacceptable for the orthodox versions of classical psychoanalysis. [ABSTRACT FROM AUTHOR]

Atlas's discussion argues that it is not only our conscious, but mainly our unconscious narcissistic and self-serving needs that prevent us from making productive use of uncomfortable countertransference experiences. It illustrates how privileging conscious awareness might repeat the same problem of keeping us in places that are too comfortable, especially when dealing with aggression and sexuality. Atlas presents a framework which highlights the generative function of enactment and emphasizes the ways analysts inevitably find themselves involved in dramatic dialogues as part of each and every treatment. [ABSTRACT FROM AUTHOR]

The relative value of insight as a mutative factor in psychoanalysis has long been a central question in the literature. Most analysts of this generation believe that although insight has clear value, it isn't normally sufficient to produce structural change in most patients. Alternatively, the tide has shifted strongly to the view that the analytic relationship per se, has more explanatory power in understanding why patients change. This essay attempts to deconstruct which elements of the analytic relationship might have the most mutative power. My argument reflects the belief that analysts' productive use of uncomfortable countertransference experience is key to ideal therapeutic outcome, whereas failure to productively use countertransference experience, usually experience that is consciously recognized by the analyst, is the primary factor in contributing to compromised or failed analyses. [ABSTRACT FROM AUTHOR]

Guided by Muriel Dimen's conceptualization of keeping "culture in mind", the current paper describes an effort to integrate relational psychoanalytic ideas with school psychology in a cultural minority group of Bedouin families in Israel. To this aim, we arranged a seminar on relational ideas for educational psychologists from different ethnicities. Four themes emerged along the course of the seminar, each representing a "meeting of the minds" between the concepts of relational theory and the Bedouin socio-cultural context: (1) reconsidering "subjectivity" and "intersubjectivity" in a traditional, patriarchal society, (2) the tension between shared mutuality and cultural norms of hierarchy and authority, (3) ethnic and political positions in transference-countertransference enactments, and (4) fantasies of sameness and difference. Our work calls for further discussions about the universality of relational theory and its capacity to positively address the needs of patients and therapists in diverse socio-cultural contexts. [ABSTRACT FROM AUTHOR]

The core seminar is the main site of supervision and reflective learning for candidates participating in the Community Psychoanalytic Track (CPT) of the Psychoanalytic Institute of Northern California (PINC). Using examples from the CPT's collaborative projects in public agencies, the paper describes the functioning of the polyvocal supervision group that investigates roles and authority relationships through unconsciously-driven transference/countertransference dynamics between individuals and groups. Themes include: issues facing the agency's client population; vicarious traumatization to agency staff; questions of framing and containment; application of community psychoanalytic theories; issues of privacy and discretion; termination challenges; and, the broader sociopolitical and cultural context. This immersive training experience helps integrate the community psychoanalytic paradigm into candidates' worldview as future analysts. [ABSTRACT FROM AUTHOR]

In this commentary, I build on Beverly Burch's (this issue) important analysis of race dynamics in a White-White dyad by exploring the way that the intersection of the overlapping oppressions of racism, classism, and sexism–within a neoliberal context–are enacted. I also argue that the clinical material suggests the limits of models that figure the sociocultural as an add-on to subjectivity and familial dynamics rather than as constitutive of them. [ABSTRACT FROM AUTHOR]

Drawing on theoretical contributions of Ogden, Goldberg, Bleger, and others, this discussion looks at how the frame is used and misused in clinical work. Imagining the psychic, conscious and unconscious meaning of the contents of the room, the waiting room and the office space, one sees how psychic material is both hidden and revealed. Using a clinical example, this discussion explores the ways analysands project disavowed and dangerous feelings into the frame, which is a complex intermediary space, neither outside nor inside. [ABSTRACT FROM AUTHOR]

This paper explores into racial presence in psychotherapy when a White therapist works with a White patient, focusing on countertransference responses. I consider ways the sociocultural and political world shape the subjectivities of both partners in psychotherapy and how Whiteness is especially difficult to see and make use of. The need for broader analyses of interactions between inner and outer worlds becomes clear when we hold this focus. [ABSTRACT FROM AUTHOR]

The author explores how the patient uses the waiting room and the relationship that he establishes with it vis-à-vis the analysis – an under-represented topic in the literature with the exception of a few authors. Drawing on field theory, Winnicott and Bion, the author examines how the patient's relationship to the waiting room as an environment houses specific self-states that may be discrepant with those that emerge in the consulting room. Similarly, there may be complimentary versions of the analyst as object in relation to the patient's discrete self-states that are specific to the waiting room in relation to the transference-countertransference dynamic. With the use of an extended vignette, the author demonstrates the importance of making use of the waiting room as an element of the treatment. [ABSTRACT FROM AUTHOR]

In this paper I offer a description of a patient with a prolonged dissociated transference and my countertransference reactions to her. Envy, both hers and mine, permeated our interactions and prevented me from dealing directly with her aggression. I will discuss the process of disentanglement and emotional differentiation that was triggered by a therapeutic crisis that penetrated the dreamlike state and led to a productive treatment of the patient's envy. [ABSTRACT FROM AUTHOR]

Enactments of contempt and counter-contempt often occur when patient and analyst become embroiled in power struggles about the nature of reality. The patient feels shamed for being deemed "out of touch with reality" while the therapist feels shamed in retaliation for being a moralistic critic making arrogant assertions about the true nature of reality. Working through enactments of contempt and counter-contempt requires that the analyst acknowledge contempt in the countertransference and how it shames the patient. It also requires working toward greater acceptance of patient behavior that seems highly offensive as the analyst may feel shamed by the patient's contempt for the analyst's viewpoint, approach to treatment, and personality. [ABSTRACT FROM AUTHOR]

A positive view is taken of integrative analytic and bio-psychological Somatic Experiencing (SE) therapy for trauma. Levit’s case report is viewed as reflecting an early stage of the analyst’s development as an integrative clinician. A risk of integrative treatments is splitting between modalities of analytic functions including affect regulation. The present case is read closely. Commentary focuses on enactment and missed opportunities for analytic reflection, including (transference) meanings of SE interventions. Increased analytic attention to therapeutic process aims to open reflective space to discuss a wide range of experiences in treatment, including disappointments and other (more negative) aspects of transference, deepening the therapeutic experience, and reaching more broadly into sequelae of the patient’s developmental trauma than SE intervention alone. Integrated bio-psychological interventions are compared and contrasted with use of psychotropic medications in analytic therapy. Bio-psychological interventions such as SE have the advantage of adding resources for the analyst’s self-regulation as well. [ABSTRACT FROM AUTHOR]

I had expected that bringing together psychoanalysis and Somatic Experiencing (SE) might be controversial. That expectation was certainly not disappointed. Although Bass resonated with much of my thinking, he also challenged the whole idea of integrating these two forms of treatment. Leddick provided extensive critique, though more about how I drew upon SE, not so much the fact that I did. While Lombardi appreciated aspects of my work with the patient, he utterly rejected the whole notion of drawing upon SE, viewing it as mechanistic, simplistic, narrowly behavioral, and merely about modulation. To address these critiques, I revisit here the clinical process with Sue, highlighting how SE is about so much more than just modulation. SE can deepen our forms of analytic holding and can help patients (re)connect with their bodies in ways that are emotionally alive, intimate, and healing. In revisiting the clinical process, I draw upon Levine, Blakeslee, and Sylvae’s in-depth discussion of SE: its goals, principles, and techniques. Though I agree with Bass’s and Lombardi’s concerns about “integration” of psychoanalysis and SE, I do not propose integration of the two, but rather interweaving of one into the other. In essence, I seek here to continue to illustrate how SE can interweave into our work, enriching our psychoanalytic ways of looking, listening, and responding. [ABSTRACT FROM AUTHOR]

This discussion elaborates the author’s use of attachment theory and research to understanding Susan’s clinical process (see Jacobs, this issue). I have delineated different patterns of attachment, its precursors in infancy, both in infant parent interactions and in parent’s state of mind with respect to attachment. I also link this to how dissociative process can be embedded in a combination of infant disorganization and trauma. I think that clinical applications of the ideas Jacobs and I subscribe to add a great deal to understanding how unformulated experiences with a frightened and frightening parent can lead to a person’s vulnerability to developing dissociative responses to later trauma. The dialogic nature of infant parent attachment experiences can further enrich an understanding of how certain transference–countertransference enactments are manifestations of certain kinds of procedural or relational knowing. In this way, clinicians can further understand the possibilities for psychic transformation as embedded in bearing that which was experienced but which cannot yet be known. [ABSTRACT FROM PUBLISHER]

This paper looks at and counters the notion that the analyst’s reluctance to know, to comprehend and interpret, the fuller meaning of a patient’s behavior is a countertransference avoidance. Drawing on attachment theory and infant research that has not yet been fully integrated into the clinical literature, the author believes that the movement from enactment to the expression of dissociated feeling is a process that leads to the creation of previously unknown meaning within an analytic impasse. The infant research literature and the literature on disorganized attachment is referenced to elucidate aspects of the clinical process. The clinical material presented involves the analyst’s failure to engage a patient’s chronic lateness, a failure that represented a mutual avoidance. The meaning of this enactment was locked in the patient’s traumatic past and could not be transmuted into new relational experience until the analyst had emerged from her own dissociative state. The therapeutic space created by their mutual avoidance, contrary to being a stalemate, became a protective space that held the meaning that was hibernating in dissociation. For the patient, the dissociated memory of traumatic abuse was linked, actually and symbolically, to her pervasive lateness. What was represented in the chronic lateness was discovered by analyst and patienttogether, along with the feelings engendered by “waiting.” [ABSTRACT FROM PUBLISHER]

My response to Kathleen McPhillips’s paper focuses on the pervasiveness of vicarious trauma for those working with survivors of childhood sexual abuse. Attempts to avoid the impact of vicarious trauma may in fact lead to denial, dissociation, or amnesia. Cultural trauma, as unearthed by the Australian Royal Commission into Institutional Responses to Child Sexual Abuse Commission, can also be linked with the wider theme of Australia’s history of migration. Migrants who came to Australia fleeing various forms of trauma, have, at times, felt betrayed by the new country. This sense of betrayal is compounded if, for example, institutional sexual abuse suffered by their offspring, is ignored or denied. The abuse suffered by children in Australian institutions has led to trauma on both personal and cultural levels. Healing, therefore, may require both individual help, and ethical responsiveness on a more collective level. The Royal Commission serves to provide a container for its examination. Such public recognition is but one step in processes of reparation that need to take place on individual and cultural levels. McPhillips’s work may also serve as a vital part of this process. [ABSTRACT FROM PUBLISHER]

This paper is presented primarily for its historical interest. The author's first attempted publication in psychiatry or psychoanalysis, it was submitted successively to two publications in 1949, rejected by each, and filed away until now. In it, the author suggests that transference phenomena constitute projections, and that all projective manifestations—including transference reactions—have some real basis in the analyst's behavior and represent, therefore, distortions in degree only. The latter of these two suggestions implies a degree of emotional participation by the analyst which is not adequately described by the classical view of him as manifesting sympathetic interest, and nothing else, toward the patient. It has been the writer's experience that the analyst actually does feel, and manifest in various ways, a great variety of emotions during the analytic hour. The analytic usefulness of this actual richness of emotional participation, by the analyst, is detailed. [ABSTRACT FROM PUBLISHER]

There is much area of agreement between the author and the discussants. The author addresses areas of concern and questions raised in the commentaries. These topics include the use of reverie, how I have defined maternal desire, concerns about the avoidance of negative transference, the analyst’s own dissociation, and compassion. [ABSTRACT FROM AUTHOR]

This paper examines the difficulties that arise with patients who experience a compromised capacity in working on a symbolic level when ensnared in specific transference/countertransference entanglements. In these kinds of situations, patients often operate in what is referred to as the concrete mode of psychic functioning in which there is an inability to think psychologically about their own mind, as well as the minds of others. Similarly, the analyst often has trouble thinking with the patient in processing the actions between them, unable to recruit the patient’s mind in becoming athinking coupletogether. Having exhausted conventional technique and interventions in trying to observe the enactment with the patient, the author argues that the analyst’s ability to grab hold of fleeting associations and memories that have not been fully processed not only expands his own mind but also facilitates symbolic functioning in the patient’s mind. By using the imagistic and sensorial substrates of these remembrances to further symbolize personal experiences, the analyst may gain entrée into the patient’s mental life. [ABSTRACT FROM AUTHOR]

Gianni Nebbiosi’s paper, “The Smell of Paper: On the Usefulness of Musical Thought in Psychoanalytic Practice,” explores many levels of the analyst’s clinical sensibility. These include the finding of a patient in the mind of the psychoanalyst, the discovery of new points of creative inflexion in developing metaphors with a patient who is frightened of symbolic meaning, the use of countertransference analysis to explore the analyst’s points of resistance to helping his or her patient, and the development of a creative shared frame of reference between patient and analyst that emerges from the patient’s unconscious life. [ABSTRACT FROM AUTHOR]

The author describes his own more expansive application of Sanford Meisner’s “Repeat Exercise” to psychoanalysis (a) as pertaining conceptually to the entire psychoanalytic situation; (b) as a practical approach to experiencing and observing the relational field, and as such might be useful in training analysts; and (c) as a way to orient the analyst, more like an organizing principle than a strategic tool for particularly problematic moments, for work in the transference/countertransference. The author also argues that the case vignette Dr. Gray presents is an intervention that has some of the effects that can be associated with a mutative interpretation. [ABSTRACT FROM PUBLISHER]

There is a long tradition of analysands who have remained silent after traumatic betrayals. The difficulty in speaking to what happened has its origins in intrapsychic, intersubjective, and institutional dynamics. In this discussion of Dianne Elise’s paper, the author explores some of the factors involved, including the sense of uncertainty about what happened and its meaning, the transference concerns about how the new analyst views the former analyst, the countertransference paralysis of the new analyst, the disillusionment of members of the analytic community, the striking differences across the spectrum of analysands in their reactions to boundary violations, and the pairing phenomenon described by Bion as it applies to groups of analysts in a community. [ABSTRACT FROM AUTHOR]

This is a discussion of Sandra Silverman’s clinical paper “The Colonized Mind: Gender, Trauma, and Mentalization.” Her patient, David née Ava, started early in life as a gender variant child. In adolescence, she became more stereotypically gender conforming. She entered treatment with Silverman as a young adult who was feeling great shame about both her past and present gender dysphoria. This discussion focuses on the clinical problem ofgender policing, its external and internal manifestations as well as its appearance in the countertransference. [ABSTRACT FROM AUTHOR]

The author reflects on his work with a child patient struggling with affect regulation, loss, and his adoption through a detailed process account of the treatment with a focus on the therapist’s inner dialogue in relation to the child’s play and words—how each affects the other. Drawing from his personal use of clinical theory stemming from multiple theoretical influences, the author shows how his associations, identifications, and tentative formulations inform his work and how the various transference/countertransference matrices influence his inner dialogue. Attention is paid to the movement from the therapist as an object within the patient’s closed system to a system that gradually becomes more open, in which the patient is able to take in the therapist’s own person as they come upon various ways to communicate and build a narrative together. [ABSTRACT FROM AUTHOR]

In this commentary on the supervisory experiences presented by Joan Sarnat and Emanuel Berman, the author mainly focuses on the following issues: the fear of facing the negative feelings and the consequences of this fear in the patient, in the candidate, and in the supervisor; on the intrapsychic/interpsychic dynamics of role-reversal in transference–countertransference; on the tendency to use either intellectual and “jargon” interpretations or metaphors without before asking ourselves whether if the patient can comprehend them or whether, on the contrary, these kinds of communications leave the patient even more disorientated and confused. Further considerations are suggested on the fruitfulness of applying “a long wave perspective” in reading the analytical material and on which an ideal “good enough” work of supervision could be intended. [ABSTRACT FROM PUBLISHER]

Csillag challenges us to consider the presence and impact of the analyst’s sadism in the clinical encounter. Her theme usefully adds to the literature on the analyst’s countertransference and pushes us to look harder at ourselves. I distinguish between sadistic intent andexperiencedsadistic impact and suggest that Csillag is mostly speaking about the latter. Additionally, I address the absence of analytic restraint as a professional ideal that might moderate our slide to sadism in the countertransference. [ABSTRACT FROM AUTHOR]

This introduction outlines a paper by Rina Lazar and discussions by Anthony Bass, Sam Gerson, and Stephen Seligman. The target paper, an extensive clinical case, is described: a case where regression, countertransference dilemmas and opportunities, and intergenerational trauma are all in play. I consider the contribution of the discussants: their unique interpretations of relational work, the distinct focus on intersubjectivity, shifting self states (Bass), intergenerational trauma (Gerson), and regression and the role and status of development (Seligman). [ABSTRACT FROM AUTHOR]

In this panel Emanuel Berman and Joan Sarnat present examples of supervisions in which anxieties disrupted their work with psychoanalytic candidates. These authors, as well as discussants Franco Borgogno and Tony Bass, concur about the importance of enlarging the scope of the supervisory process beyond the traditional focus on the patient and on supervisee countertransference, narrowly defined, when such disruptions occur. [ABSTRACT FROM PUBLISHER]