Psychoanalytic Psychology

Fuchshuber, Jürgen; Unterrainer, Human-Friedrich; Kapusta, Nestor D.; Blüml, Victor

doi: 10.1037/pap0000549pmid: N/A

Significant research has been dedicated to the relation between childhood adversities and the development of personality structure. The present research aims to contribute to this exploration using a data-driven network approach. Specifically, the study psychometrically investigates the relationships between personality organization (PO) and childhood trauma (CT). A total sample of 1,110 participants from the general population (68% female) was analyzed in terms of personality organization (IPO-16) and childhood trauma (CTQ) within a pairwise Markov random fields model. The network was estimated using the EBICglasso algorithm. Regularized partial correlation edge weights, node centrality indices (estimated influence, strength, bridge strength), and predictability were examined. Significant correlations were observed between PO and CT across all subdomains (p < .001). The analysis of the regularized partial correlation network revealed a significant edge between primitive defense and emotional abuse, representing a bridge between PO and CT. This finding was supported by the high centrality indices of both emotional abuse and primitive defense. The findings suggest that the relationship between CT and PO is primarily mediated by the link between primitive defense mechanisms and experiences of emotional abuse in childhood. The implications of these psychometric results are discussed within the context of psychoanalytic theory and clinical practice.

doi: 10.1037/pap0000551pmid: N/A

Influenced in part by object relations theory, contemporary models of personality pathology are converging in their emphasis on the central role of the self and interpersonal functioning. However, they have largely not adopted object relations theory’s assumption that personality disorder style and personality disorder severity are linked. The present study was designed to investigate the relationship between personality disorder style and severity in an inpatient adolescent sample. Categorical personality disorder diagnoses were converted into (a) personality style groups, permitting group comparisons, and (b) a dimensional personality style score, permitting correlation analyses with measures of personality organization and clinical severity. Group differences and correlation analyses both demonstrated that personality disorder style is associated with clinical severity in our sample. Mediation analyses further demonstrated that, for three of four clinical severity constructs, the relationships between personality style and clinical severity were mediated by differences in personality organization impairment. Results were broadly supportive of hypotheses, providing support for the object-relational model of personality diagnosis.

doi: 10.1037/pap0000556pmid: N/A

The purpose of this article is to enrich and elucidate the connections between attachment research and psychoanalytic practice, linking Bowlby’s psychoanalytic origins with the influential body of research produced in this field. The findings on attachment disorganization will be examined from two standpoints. The first regards what is “behind” it, namely the origins of disorganized attachment, as illustrated by Beatrice Beebe’s research on the precursors of attachment patterns identified from microanalytic nonverbal communication between 4-month-old infants and their mothers. The second pertains to what is “beyond” it, namely the trajectories of attachment disorganization after childhood and specifically in the context of the couple bond, where disorganized attachment patterns may be observed. Drawing on Bowlby’s proposal that conflict arises when two or more incompatible systems are at play, this article will propose that the compelling need of being seen and known frequently coexists with fear, activating the attachment system in contradictory ways. The article will then explore the clinical value of considering attachment and recognition in their entanglements. A clinical vignette will illustrate the ways in which these systems may act simultaneously, determining conflict, competition, dissociation, and even disorganized/disorganizing states.

doi: 10.1037/pap0000552pmid: N/A

Transference interpretations have the potential to address unconscious interpersonal conflicts that find reflection in the therapy relationship and improve the patient’s psychosocial functioning; however, they should be practiced in the context of a strong therapeutic alliance so as to prevent adverse effects. Despite their conceptual relations, the impact of the therapeutic alliance on transference work in the treatment of adolescents has not been previously examined extensively. This study was the first to examine whether a strong therapeutic alliance predicted the use of transference interventions in a single case of adolescent psychodynamic psychotherapy. The case of the study was a 16-year-old Turkish adolescent male, with anxiety and attention problems. A total of 57 sessions that cover his entire treatment were transcribed and coded for both therapeutic alliance via the Therapy Process Observational Coding System–Alliance Scale and transference interventions by the Transference Work Scale. Time Series Granger Causality Tests indicated that transference interventions that address the therapist directly in the interpretation were used only when therapeutic alliance was stronger. Strong therapeutic alliance may provide the necessary context for the therapist to use transference interpretations that contain elements of the here-and-now relationship.

doi: 10.1037/pap0000559pmid: N/A

In contrast to other major schools of psychoanalysis, Lacanian psychoanalysis views the concept of empathy with circumspection because, as a way of knowing something about the analysand’s experience, it is seen to operate in the Imaginary order; that is, empathy from this perspective understands the other’s experience on the basis of one’s own experience, thus colonizing the other’s difference and obscuring the domains of the unconscious and the Real, or that which escapes and resists being symbolized. The present research seeks to critically question and complicate this view of empathy in Lacanian psychoanalysis. Using transcriptions of our qualitative interviews with 12 practicing Lacanian analysts about their views on empathy and what place if any it has in their analytic practice, we conducted a reflexive thematic analysis to discern how empathy may play a number of unacknowledged roles in Lacanian psychoanalysis and/or be used in novel ways that might contribute to the theorizations of empathy within Lacanian as well as other traditions of psychoanalysis. To interpret the analysts’ viewpoints, we used Lacanian discourse theory because it provides an account of how Lacanian analysts listen and intervene in analytic practice. We applied a reflexive thematic analysis to identify four themes: empathy in the Imaginary can be harmful, empathy in the Imaginary can be helpful, empathy exercised from the analyst’s position in the Symbolic can honor the difference of the analysand, and such an empathy can be attuned toward the Real or the impossible but without claiming to understand.

doi: 10.1037/pap0000557pmid: N/A

Binge-eating disorder (BED) is characterized by recurrent episodes of binge eating involving the consumption of large amounts of food accompanied by a marked loss of control. Individuals with BED tend to exhibit affect dysregulation, identity diffusion, use of immature defense mechanisms, and difficulties distinguishing between mental and somatic states. The present study examined the clinical case of a 25-year-old patient with a Diagnostic and Statistical Manual of Mental Disorders-5-TR diagnosis of BED, who was receiving treatment at a specialized residential treatment center. Upon intake, the patient presented with an insecure-preoccupied attachment style, avoidant personality disorder with dependent and schizoid traits, low defensive functioning, and marked symptom impairment. A comprehensive psychodynamic-oriented treatment, incorporating a multimethod and multi-informant approach, resulted in meaningful structural and symptomatic improvements, particularly in personality organization, defensive patterns, and symptom severity. The findings underscore the clinical importance of the structural reorganization of core areas of functioning in patients with BED, necessitating an individual approach to treatment.

doi: 10.1037/pap0000550pmid: N/A

The most important recent contribution to mentalization theory is the construct of epistemic trust. It serves as a bridge from the theory’s roots in attachment to its current affirmation of the primacy of social communication. Epistemic trust refers to the capacity to trust in the authenticity and relevance of interpersonally transmitted knowledge. Epistemic trust evolves alongside a stance of epistemic vigilance, which, in many ways, works to buttress and reestablish epistemic trust. Epistemic vigilance is stimulated by ambiguity about trust and thus requires effort to determine whether epistemic trust should be granted or withheld. To date, the emphasis of epistemic trust and epistemic vigilance is on cognition, while the present article proposes that both trust and vigilance integrate cognition with emotion. Both epistemic trust and epistemic vigilance are linked to the construct of mentalized affectivity, the capacity to modulate emotions through reflection on autobiographical memory. Last, epistemic injustice refers to an exclusion, silencing, or undermining of one’s capacity to be a knower. Commonly found in testimonials and within systems that minoritize certain identities and backgrounds, epistemic injustice is also prevalent in the context of psychotherapy even with the best intentioned and ethically informed therapists. Ultimately, this article shows how the three constructs can be utilized clinically. A case example is used to illustrate our understanding of each construct and to provide clinical implications for the psychodynamic psychotherapist. A mentalizing stance by the therapist is ultimately proposed as a counterbalance to epistemic injustice.

doi: 10.1037/pap0000547pmid: N/A

Psychological assessment involves the use of validated measurement tools to answer specific questions. However, there are a wide range of available tools, a variety of reasons for choosing them in any given clinical context, and very little evidence to guide instrument selection. Experienced clinicians may have intuitions about which tests to use to answer specific questions, and psychoanalytic theory provides a structure within which to consider what kinds of tests to use in different clinical situations. In this article, we review common considerations for selecting tests in clinical assessment from a psychoanalytic perspective. We then use a case to illustrate how four expert assessors who work in different contexts and have somewhat different backgrounds demonstrate their approach to test selection in answering specific collaborative assessment questions. Similarities and differences between these experts are discussed, with an eye toward developing a more systematic model for test selection that could be helpful to psychodynamic assessors and provide a foundation for applied research.

doi: 10.1037/pap0000546pmid: N/A

This article offers a psychoanalytic exploration of acts as erotic and transformative forces, foregrounding the impact of intersectional feminist activism on psychoanalysis in Latin America over the past decade. While psychoanalysis has often approached the “realm of action” with caution—frequently framing it as forms of acting out or failures of symbolization—this article proposes an alternative to understand acts as openings charged with erotic force, offered under the pressure of the sexual unconscious. Drawing on multisited ethnographic research in Argentina, Brazil, and Chile, and engaging Lacan’s theory of the analytic act alongside Laplanche’s concept of the enigma, the article advocates a shift toward recognizing acts as eruptions of unbinding that disrupt patriarchal and colonial norms and enable new translations of the sexual unconscious. In doing so, it offers a framework for engaging the erotics of the act as a field of interruption, libidinal reconfiguration, and invention.

doi: 10.1037/pap0000555pmid: N/A

Interdisciplinary work between psychoanalysis and computational neuroscience has led to iterations of psychoanalytic theory (M. L. Solms, 2018). Importantly, it has bolstered orthodox psychoanalytic claims of dreams revealing unconscious beliefs, using the language of predictive processing (Koslowski et al., 2023; Nir & Tononi, 2010). Within predictive processing, dreams are equivalent to memories or hallucinations, where visual imagery is predicated upon deeper priors in “mnemonic” and “libidinal” systems. Dreams are suggested as elaborating priors—from nondeclarative forms into declarative form (Koslowski et al., 2023). Also enabling the affect to be better revealed, due to secondary defenses when awake. With a predictive processing account of eye movement desensitization reprocessing postulated by Chamberlin (2019), it is logical to suppose eye movement desensitization reprocessing could remediate distress caused by repressed priors, as revealed in dreams. This article provides grounds to explore dreams as material in eye movement desensitization reprocessing, extending its therapeutic scope.