Psychoanalytic Psychology

Fischer-Kern, Melitta; Buchheim, Anna; Hörz, Susanne; Schuster, Peter; Doering, Stephan; Kapusta, Nestor D.; Taubner, Svenja; Tmej, Anna; Rentrop, Michael; Buchheim, Peter; Fonagy, Peter

doi: 10.1037/a0020862pmid: N/A

Relationships between personality organization, reflective functioning (RF), and the number of Axis I and Axis II disorders were examined. Ninety-two female patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV–TR) borderline personality disorder (BPD) were administered the Structured Interview of Personality Organization (STIPO), the Adult Attachment Interview for assessment of RF, and the Structured Clinical Interview for DSM Disorders. Significant correlations were found between the level of personality organization and the number of Axis I and Axis II diagnoses. In contrast, no association was found between RF and the severity of Axis I and Axis II pathology. RF and level of personality organization were moderately associated. The results indicate that the concept of personality organization is related to the descriptive approach of the DSM–IV–TR. The STIPO provides a differentiated picture of the severity of personality pathology and allows dimensional ratings of several domains central to personality functioning. The RF findings confirm previous studies indicating impairments of mentalizing capacity in BPD patients. The association between RF and level of personality organization supports both shared and divergent conceptual considerations underlying mentalization and personality organization. Further investigation of the relationship between these structural constructs would shed light on the complex interplay of an individual's capacity to mentalize and the personality structure shaped by identity integration, defense mechanisms, and reality testing. In addition to the psychiatric classification, measurements of RF and personality organization should be considered in psychotherapeutic treatment planning as well as evaluation of therapy response.

Cortina, Mauricio; Liotti, Giovanni

doi: 10.1037/a0019510pmid: N/A

The relationships between intersubjectivity and attachment are beginning to be explored within the psychoanalytic and developmental literature. We contribute to this comparative effort by exploring the different evolutionary origins of attachment and intersubjectivity. Five interlocking themes are central to this article. First, from an evolutionary perspective, attachment and intersubjectivity serve different functions. The main function of attachment is to seek protection, whereas the main function of intersubjectivity is to communicate, at intuitive and automatic levels, with members of the same species and to facilitate social understanding. Second, to survive in changing and highly competitive environments, an evolutionary strategy emerged among our human ancestors based on developing high levels of cooperation within small bands of hunters and gatherers. In turn, high levels of cooperation and social complexity put selective pressures toward developing effective modes of communication and more complex forms of social understanding (mindreading/mentalizing/intersubjective abilities). These abilities far surpass mindreading abilities among our closest Great Ape relatives. Third, we provide further evidence for this hypothesis showing that in comparison with other Great Apes, young children show qualitatively different levels of collaboration and altruism. Fourth, we provide an overview of the development of attachment and intersubjective abilities during the first 2 years of life that support the hypothesis of a cooperative origin of intersubjectivity. Fifth, we return to the main theme of this article showing three ways in which attachment and intersubjective abilities can be distinguished. We conclude by exploring some clinical implications of this cooperative–intersubjective model of human development.

Marmarosh, Cheri L.; Bieri, Kathryn; Stuber, Emily; Gunnia, Karthik; Nwigwe, Maxine; Sevilla, Colleen; Rice, Kathryn

doi: 10.1037/a0020846pmid: N/A

Eight-one first-year doctoral students in a psychodynamic program completed the SWAP-200 on a standardized case to determine the usefulness of the instrument with novice clinicians and to assess race-based differences in diagnostic outcome. The test case represented either a Caucasian or an African American woman who had either a masochistic or an obsessive–compulsive character style. Results revealed that the SWAP-200 was able to detect differences between the obsessive and masochistic cases in theoretically consistent ways. Although the SWAP-200 was useful with novice clinicians, the results revealed that the African American patient was rated as having greater narcissistic and antisocial features than the Caucasian patient. The Caucasian patient was rated as having greater avoidant, dependent, and depressive features compared to the African American patient. Implications of the findings and recommendations for training and future research are discussed.

Harlem, Andrew

doi: 10.1037/a0020755pmid: N/A

The author explores “exile” as both a migratory and psychological phenomenon, with particular emphasis on it as a state of mind—one that, by virtue of the dissociative processes by which it is characterized, forecloses the (psychic) possibility of immigration. From this point of view, an exile is not simply one who cannot (physically) return; she is someone who cannot “remember” other versions of herself, who cannot bridge the gaps between versions of self rooted in disparate times, physical spaces and relationships, who cannot “stand in the spaces” between self-states. With a view of clinical process that forefronts dissociative phenomena in both patient and analyst/therapist, and their enactment in the therapeutic relationship, the author describes various forms of exile that emerged in working with his patient, Maria. He focuses on how, over time, the enactment of negation or “not-ness” (specifically, “not-Germanness” and “not-Jewishness”) in the therapeutic relationship catalyzed recognition and negotiation of exiled self-states in both patient and therapist—self-states that could themselves be understood as refractions of transgenerational exile, rooted in the respective (and respectively denied) European heritages of both patient and therapist.

Goldman, Dodi

doi: 10.1037/a0020453pmid: N/A

Generational dialogue refers to both shifts in relatedness between generations as well as how the otherness of predecessors and successors are negotiated internally. At various points in the life cycle, the need for generational dialogue is rekindled. As a new place within the generational cycle is inhabited, the individual contends with a novel version of the self and the influences that other generations, both older and younger, exert. Since each new generation's place needs to be claimed and not simply conferred, clashes within and between subjectivities are inevitable. Doubts about the self give rise to a “sorting out” process of which generational dialogue is a part. Clinical examples illustrate the unconscious search for generational dialogue and how it might be engendered or thwarted in analytic work.

Rosegrant, John

doi: 10.1037/a0020452pmid: N/A

Psychoanalysis works with three views of reality: factual reality, psychic reality, and coconstructed reality. The history of clinical psychoanalytic thinking about trauma demonstrates that these realities are often in conflict with each other and that they have cycled in use without any consensus developing about which is most correct. These three realities have also been used without consensus by the broader mental health field and in the study of myths, indicating that these realities are fundamental ways of understanding ambiguous psychological data. The uncertainty as to which reality is most correct is resolved by recognizing that it is part of the human condition to be constantly differentiating and integrating these realities, and so we best help our patients by engaging with them in the process of applying all three, rather than by making definite static decisions about which is most applicable. This approach is demonstrated with clinical material.

Våpenstad, Eystein Victor

doi: 10.1037/a0020454pmid: N/A

This article is about ambiguity in psychoanalysis, an ambiguity that is particularly striking in the psychoanalytic relationship between patient and analyst. The analyst is a professional in his consulting room, in his chair behind the patient, but he is at the same time a figure in the patient's realization of his inner world of objects. The analyst is a transference figure, but he is also a real person with his own inner private reverie and a subjective contribution to the analytic process. For some patients, the ambiguous analyst is an enormous challenge or threat. This article describes parts of the analytic process with one such patient, a man with an early history of severe trauma who at the start of his treatment completely denied this ambiguity and felt every reminder of his analyst being anything else but professional as a threat to his sanity. The author tries to show how the improvement of the patient's tolerance for ambiguity depended on the work done in the analyst's private reverie, a quite demanding process for the analyst.

Jurist, Elliot L.

doi: 10.1037/a0020845pmid: N/A

Paul Wachtel has done it again. After writing for many years about integrating psychoanalytic, behavioral and family approaches to psychotherapy in addition to cultural issues, Wachtel has returned to his psychoanalytic origins to explicate his ideas about cyclical psychodynamics from the perspective of contemporary relational psychoanalysis. This book is an excellent way for psychotherapists unfamiliar with how psychoanalysis has changed since Freud to familiarize themselves with recent developments from a writer who does not get lost in the jargon that distances many who find psychoanalytic language lacking in clarity. Psychoanalysts will find some critiques of traditional views and expansions of ways of looking at the clinical situation.

Jurist, Elliot L.

doi: 10.1037/a0020960pmid: N/A

Jurist, Elliot L.

doi: 10.1037/a0020416pmid: N/A