Theory of Clinical Practice

Recent contributions to the psychoanalytic literature propose new ways of understanding analytic neutrality, anonymity, abstinence, and self-disclosure. They advocate elective self-disclosure by the analyst as an antidote to the allegedly game-playing quality of transference and resistance analysis. The analytic relationship, they assert, becomes unreal when attempts are made to observe the principles of neutrality and abstinence. Both are seen as ill-conceived because of the irreducible subjectivity and unwarranted authority of the analyst. These relational and interactional views are criticized because (1) they ignore the fact that transference and resistance analysis have from Freud onward been accepted as minimal criteria qualifying a clinical process as psychoanalytic; (2) elective self-disclosure carries metapsychological implications dismissing not only Freud's theory of motivation but motivation as a basic feature of human personality; (3) they do not recognize interpers...

The title of my talk is “Edges of the Voice in Psychoanalysis.” I am interested in these edges, the ways in which, through writing or speaking, we experience a limit and push beyond it. On the one side of this limit is our indelible subjectivity, that our voice is ours, and sounds only like one person—me in my case and you in yours—and no one else.2 On the other side is the voice as a worrisome and odd Thing, a source, as I will describe, of discontent and suspicion. These two sides sit one against the other in tension.

This essay traces my work in co-developing a pedagogical framework for PhD supervision together with Gregor Noll, as I worked pursuant to a doctoral degree in international law. It draws on French psychoanalytic scholar Jean Laplanche and argues that the notion and practice of transference in the psychoanalytical situation - as part of psychoanalytical theory and practice - may be helpful as a pedagogical tool for PhD supervision in international law and beyond.

As analysts become more experienced, theoretical knowledge becomes more integrated and implicit and is gradually transformed into the practical wisdom (phronesis) described by Aristotle. While this leads to greater freedom in ways of working, it remains conditional on the consistent disciplined practice represented by the analytic attitude. In the context of my own development as an analyst, I suggest that increasingly the analyst works from the self rather than the ego and link this with Fordham's account of 'not knowing beforehand'. Some implications for boundaries, enactment and the use of personal disclosure are discussed in relation to clinical material. I compare analysis with the wisdom traditions of religious practice and suggest that analysis is concerned with a way of living rooted in humane values of compassion and benevolence.

Self-disclosure has been discussed from many different perspectives. In this article, I explore yet another dimension of this expanding area of our literature: the disclosure of a therapist's disability. I describe my own conflicts over how to talk about my visual impairment with patients-the result of a degenerative eye disease-in a way that respects the patient's right not to know something about me. Using a clinical vignette, I describe how my ambivalence over this disclosure became enacted in my work with a college student, and how the eventual disclosure of my vision led to a greater establishment of intimacy in the therapy, and a generative experience that continues to ripple through my current work.

has gifted us with an exciting new book, Freud's Papers on Technique and Contemporary Clinical Practice. The book is primarily a collection of Friedman's previously published papers, with the addition of a helpful introduction, three orienting prefaces, and a short end section. We have the privilege of following Friedman as he thinks through, with great rigour, depth, and insight, issues inherent to what Friedman sees as Freud's empirical discovery of the "strange" experience that is "the psychoanalytic experience … a novel state of unusual mental freedom" (1; all quotes in this review are from Friedman). The papers-now chapters-are beautifully written in prose that is non-technical, clear, and suffused with wit. However, they are not always easy reading. They require concentration and thought, as Friedman takes us into a question, leading us as he thinks it through, always considering and evaluating different alternatives that would challenge or modify his main point. Friedman tends to begin with a thesis, based on an aspect of the analytic stance. He develops it, and then moves to questioning it, often based on post-Freudian challenges. He then challenges the challenges, and ends with a conclusion that reaffirms the initial thesis (and Freud's thinking). The papers are masterful contributions, one after the other. Friedman's focus throughout is on how the analyst's "attitudes" (170) allow the psychoanalytic experience to unfold. He sees Freud's technical recommendations-abstinence, neutrality, and anonymity-as default positions for the analyst, "beacons" (142) within which he can establish and maintain the psychoanalytic phenomena that Freud discovered, and tolerate the necessary ambiguity and paradox that psychoanalysis demands. Friedman writes: "It bears repeating that most of those anti-analytic attitudes (the 'don't's) that Freud's Papers on Technique cautions against are normal social attitudes. It is the task of training to make what is perfectly normal feel inappropriate to analysts while they are at work" (224). Friedman stresses that Freud's technique papers are best understood as a whole. I will review Friedman's book in a similar way, looking at the whole book and his central argument as it develops through the various chapters. I will quote him frequently, so that the reader gets a feel for his writing. Friedman's first point is that Freud's Papers on Technique, as a whole, are a record of Freud's experience. "The technique is not deduced from a model of the mind" (4). Freud's recommendations of anonymity, abstinence, neutrality, etc. are not derived from his drive theory. Rather, Freud's book records "an experiment in the evocation of a certain state of mind; specifically, to see what brings about that particular state and what interferes with it" (3, original emphasis). Psychoanalysis was Freud's "discovery" (3) and the Papers on Technique record Freud's process of discovery. This is important because it allows us to think about Freud's technical recommendations empirically, as ideal positions that affect the unfolding of a psychoanalytic process. We can think, for example, of these recommendations as facilitating or interfering with a patient's capacity to "flirt" with a "virtual reality" (Chapter 9). We can also look at how different analysts balance or collapse the always ambiguous interplay of illusion and "reality," as a way of differentiating between analytic approaches, as Friedman does (150-151, 172-174, for example). Friedman uses Freud's Papers on Technique as the base of his discussion of the analytic stance, and the cornerstone of this base is Friedman's understanding of Freud's concept of working through. Friedman asserts, in three chapters offering close readings of Freud's papers, that Freud concluded that working through is the major mutative agent of psychoanalysis. Working through occurs "in a patient's private experience" (51). Working through is the

Psychoanalytic therapists are today far more aware of countertransference effects, intersubjectivity, and mutual influence. The area that has been explored least in this two-person appreciation of psychoanalytic process is the effect of the psychodynamics of the therapist in a wide sense-that is, how the therapist brings a whole psychology, with a wide array of potential transferences, to each treatment. Triggered by the unexpected announcement of a patient's expecting a baby, the author reviewed his practice and found that a large portion of his women patients ages 30-45 had become pregnant during therapy or psychoanalysis. The particulars were varied: how much the patient wanted a baby, whether the treatment was psychotherapy or psychoanalysis, the patients' personality structure. Was the analyst's psychology a common factor? The paper presents three quite different case examples and examines whether and how the author's developmental and inner experience of women, sexuality, pregnancy could have contributed to a dyadic process that, in turn, could lead to pregnancy. If such effects happen, then it is important to look beyond and behind "anonymity" and "neutrality," as well as momentary countertransferences, to the real-life effects that we have in our treatments. 1 A very rough review of my practice suggests that more than one third of the patients in the possible group got pregnant during treatment, and another third had a child subsequently (letting me know), for a total of two thirds of the total. My impression is also that this proportion increased to roughly half, as my practice continued, and I saw more women in the latter part of the child-bearing years (ages 30-45). As a baseline comparison, the average child-bearing rate for the age group 30-45 in recent years is 5.5%/year. If my treatment contacts averaged 5 years in length, the "control group" rate would be 28%. My patient population tended to be in the 35-to 45-year-old range, where the "control" rate would be 17%.

Abend' s paper is a gift for any author wanting a summary of where conflict theory (sometimes called "classical theory" by those who don' t embrace it, much to the annoyance of those who do and hear, in the word classical, the innuendo of old and outdated) stood on the question of countertransference thirty years ago, to be used as a launching pad from which to discuss developments in how we have been writing about it since then. His writing is clear and unambiguous (or as unambiguous as one could hope for, in the face of continued confusion/debate about such fundamental topics as the therapeutic action of psychoanalysis or how the mind works-especially unconsciously). Since then, the literature on countertransference wrestled with the problem that, while having a certain feeling at a specific moment can be treated as a fact, analysts, as is also true for patients, must interpret that feeling; and then analysts must make clinical choices about how to use their interpretations of their countertransference emotional experiences, and must also make clinical choices about how to respond to analysands' interpretative readings of their analysts.

Though it is unlikely that instituting universal guidelines will ever be possible for patient approval of the analyst's use of clinical material outside of the treatment setting, the author offers some supplementary refl ections to those already available in the literature. Broadly applied informed consent guidelines would increase the distortion that already exists in our clinical literature due to self-imposed restraints by writers. Moreover, the powerful irrational forces mobilized by consent in the dyad are not easily 'held' by traditional applicable legal categories. Metapsychological formulations of the intrapsychic and intersubjective impact of patient participation in the writing process on individual analytic dyads are needed. Notions of privacy protection, validation, dyadic co-construction, or writing-as-containment by a third as rationales for informed consent fail to encompass the transindividual and external sources of human identity and the ineradicable lack of unity in the unconscious. Nevertheless, theoretical affi nity and preferred technique may be mediating factors in positive outcomes of the consent process. Some paradigms not only accommodate more comfortably but also actively seek the intersubjective repercussions of informed consent. As an alternative or complementary viewpoint, the author offers the hypothesis that the clinical ramifi cations of either disguise or consent are not exclusively, nor even necessarily, concerned with what patients read about themselves, but what they assess or intuit-directly or indirectly through the material presented-of their analyst's unconscious strivings. To truly triangulate the clinical reporting project, it is wisest to consult the third ear of a colleague to assess the potential impact on patients on what might be being unconsciously transmitted by the analyst in the writing and the consent process.

Research on the Efficacy of Psychoanalysis' The crucial need for, and difficulty with, conducting efficac research the research prograni of Judy Kantrowitz et al., as well as evaluate their newer direction. Their 15-year effort, which aimed to assess the effectiveness of psychoanalysis in a 2 I-case sample, initial1 attempted treatment interviews and projcctive tests (Rorschach, TAT, etc.). The criteria were grounded in four global "psychological aspects": reality testing, affect availability and tolerance, level and quality of object relations, and motivation. Results failed to show that these variables predicted analytic result or outcome. T h e study determined that patients did show "therapeutic benefit," b virtue of improvement in e o functions after psychoanaly-However, no systematic relation between this kind of "therapeutic benefit" and "analytic result" could be discerned. At long-term followup, neither the treating analysts' assessments at termination nor patient self-assessments or ratings of their res onses to psychological

My response to Beritzhoff's paper focuses on the central relationship between play and the development of the self. I argue that her presentation of a set of ideas and clinical techniques for actively fostering a potential play space is courageous in the context of a history of psychoanalytic controversy about the activity of the analyst. I also point out that her effective work with her melancholic patient could apply to many different kinds of patients, as well. I then try to highlight Beritzhoff's ideas by showing their usefulness in a case of my own-a patient very different from Janet who was able to develop his sense of self through play. To comment on this paper is an honor. It is a pleasure to read such eloquent writing and passionately felt ideas, and Lisa Beritzhoff's generous contribution of detailed case material gives us all an opportunity to learn from her hard work. WHAT IS ADULT PLAY THERAPY? One of the most fascinating areas of exploration in our field centers on our understanding and use of play in adult therapy and analysis. Beritzhoff's paper takes us further into this territory and experiments with methodology as well. She tells us that her relationship with her patient Janet will illustrate, among other things, a "mutually created, unique form of adult play therapy" that involves a squiggle-game collage, inventing scripts for episodes of a television show, and two mutually created, evolving fantasy narratives about the patient-analyst relationship (p. 707). Because play in adult therapy doesn't usually involve the concrete playing of games or making up stories, Beritzhoff is extending our technique in adult therapy in a very exciting way. What is playing in adult therapy? In one sense, we know that adult therapy and all therapy is always about play. However, if analysts and therapists, as a group, had to pick one idea, perhaps we might agree that a central concept about play is its role in the birth of the self. Winnicott (1971) got to the core of this point in Playing and Reality when he said, "It is in playing and only in playing that the individual child and adult is able to be creative and Correspondence should be addressed to Zoe Grusky, Ph.D.,

Bruce Fink starts his paper by pointing out that there is "no single Lacanian approach to psychoanalytic practice." This is accurate, firstly, because it is unclear what it is to be Lacanian. When in 1980, having dissolved the institution he had created, Lacan travelled to Caracas to address his South American "pupils," he stated: "I come here before launching my Freudian Cause. You can see how important this adjective is to me. You'll be Lacanian if you want. Me; I am Freudian." (Lacan 1980) In addition, Lacan never defined the canon of an orthodox Lacanian practice as he was discovering it all his life, through experimentations with the Freudian model. On one hand, Lacan practised in different ways when he was a young analyst, a less young analyst and eventually a great master, and with this particular analysand or that one. On the other, he contributed an enormous theoretical edifice, which remained for a long time unwritten. Bruce Fink, humbly but also realistically, suggests that the Lacanian community may shiver at the fact that it is an American analyst who has been granted the prestigious task of writing this paper in the holy journal of the IPA, an organisation that Lacan, once president of the Société Psychanalytique de Paris and training analyst, never wanted to leave. Maybe his own grasp of Lacanian theory is "thought by some in the Lacanian community to be overly direct, transparent, and simplistic … " but what makes him particularly fit to achieve this challenging task is twofold: there is no doubt that he has read Lacan, and he is an outsider. Having "devoted the past 35 years to grappling with and translating Lacan's often difficult work," Fink has not only read a great deal more than most but also had to ponder the meaning of the text. Beyond negotiating the didactic function of its ambiguity, metaphors and jokes, the fruitful digressions about the previous evening's conference somewhere or a veiled reference to a friend's clever and useful comment, translating Lacan's text means settling on a meaning. In addition, a career in American academia placed Fink outside the grip of psychoanalytic institutions and allowed him to say what he wished without too much concern about the impact it could have on his future. The first idea specifically associated with a Lacanian approach in this paper is about the radically different approaches to treating neurosis and psychosis. Fink refers to the Lacanian concept of structure as opposed to what today would be called disorders. People "who have never shown any of the well-known florid symptoms of psychosis, such as hallucinations and delusions" have nonetheless a psyche that tends to externalise and attribute to someone else their own unconscious desires, to expect the other's hostility, or that

As analysts become more experienced, theoretical knowledge becomes more integrated and implicit and is gradually transformed into the practical wisdom (phronesis) described by Aristotle. While this leads to greater freedom in ways of working, it remains conditional on the consistent disciplined practice represented by the analytic attitude. In the context of my own development as an analyst, I suggest that increasingly the analyst works from the self rather than the ego and link this with Fordham's account of 'not knowing beforehand'. Some implications for boundaries, enactment and the use of personal disclosure are discussed in relation to clinical material. I compare analysis with the wisdom traditions of religious practice and suggest that analysis is concerned with a way of living rooted in humane values of compassion and benevolence.

Analysts have ciiaracteristic stjles in working with their patieiits. At times of crisis or staleniate, aii alteration in stjle niay facilitate the progress of the treatmia,i&. To illistrate the itnkedirig effects of mi analjtic sljle at a partictilar phase of aiialjsis, I describe a staleinate iii &he analjsis of a severelj self-ciitical patielit. Recogiiitioii of the linitiiig esfecls of sljle oii the &reatitieii& becaiiie n/$areii& iii a coic,itertraiisfereiice eiiactitieiit, i@ flueiiced by tile patieiit-ciiinljsL inatch. Self-aiinlyis and alteration i i i the charncteristic stjle of the analyst resolved &he stalemate aiid eiiabled the ana@ic work to progress. ACH ANALYST POSSESSES A CHARACTERISTIC Style in conduct-E ing analytic work. This style is the result of conscious choices as well as more fundamental, generally unconscious, configurations of character. Of course, each individual style has variations and, depending on the characteristics of the particular patient, some aspects of the analyst's style are more prominent in one analysis than in another. Overall, however, there are identifiable qualities in each analyst's mode of working which are distinctive, and certain general tendencies in the analyst's methods which permit broader categorization. One of the possible categories is the analyst's perspective on the patient's experience. Some analysts tend to expand the patient's own point of view, in contrast to offering a perspective emphasizing Training and Supervising Analyst, Boston Psychoanalytic Institute; Instructor, Department o f Psychiatry at Beth Israel Hospital, Harvard hledical I wish to thank Dr. hi. Robert Gardner for both the hclpful consultatiori and review of this paper. I also wish to thank Drs. Natalie Bluestone, James Dalsimer, Paul Kantrowitz, Anton h i s , and Judith Yanof for reviewing this papcr and for their thoughtful suggestions. Accepted for publicativri hlay 8, 1990. School,

Analysts have ciiaracteristic stjles in working with their patieiits. At times of crisis or staleniate, aii alteration in stjle niay facilitate the progress of the treatmia,i&. To illistrate the itnkedirig effects of mi analjtic sljle at a partictilar phase of aiialjsis, I describe a staleinate iii &he analjsis of a severelj self-ciitical patielit. Recogiiitioii of the linitiiig esfecls of sljle oii the &reatitieii& becaiiie n/$areii& iii a coic,itertraiisfereiice eiiactitieiit, i@ flueiiced by tile patieiit-ciiinljsL inatch. Self-aiinlyis and alteration i i i the charncteristic stjle of the analyst resolved &he stalemate aiid eiiabled the ana@ic work to progress. ACH ANALYST POSSESSES A CHARACTERISTIC Style in conduct-E ing analytic work. This style is the result of conscious choices as well as more fundamental, generally unconscious, configurations of character. Of course, each individual style has variations and, depending on the characteristics of the particular patient, some aspects of the analyst's style are more prominent in one analysis than in another. Overall, however, there are identifiable qualities in each analyst's mode of working which are distinctive, and certain general tendencies in the analyst's methods which permit broader categorization. One of the possible categories is the analyst's perspective on the patient's experience. Some analysts tend to expand the patient's own point of view, in contrast to offering a perspective emphasizing Training and Supervising Analyst, Boston Psychoanalytic Institute; Instructor, Department o f Psychiatry at Beth Israel Hospital, Harvard hledical I wish to thank Dr. hi. Robert Gardner for both the hclpful consultatiori and review of this paper. I also wish to thank Drs. Natalie Bluestone, James Dalsimer, Paul Kantrowitz, Anton h i s , and Judith Yanof for reviewing this papcr and for their thoughtful suggestions. Accepted for publicativri hlay 8, 1990. School,

Today the importance of working through the analyst's countertransference is stressed throughout all different schools of psychoanalysis. This article aims to make the microprocesses more transparent regarding the transformations of transference and countertransference, from the beginning of the anchoring of a projection in the analyst up to the re-internalization of a transformed projection in the patient. This is introduced by a survey of the history of two central terms: Projective Identification (on the side of the patient) and Countertransference (coming from the side of the analyst). How the analyst is also a "do-er" and how this fits in with the projective identifications of the patient is a newer development in psychoanalysis and is the main subject of this paper. Alongside the clinical material shown is described what the patient triggers in the analyst with his projections, and how the analyst manages to work through his countertransference where the patient becomes a temporary object, connecting with objects of the analyst until-if all goes well-the analyst manages to transform the projection of the patient while "triangulating with his inner understanding parents".

This paper is about a central and mostly overlooked aspect of the unconscious as manifested in the clinical work of psychoanalysis. This is its proleptic nature. The unconscious is proleptic in that it performs futural possibilities for the subject. These futural possibilities emerge as potentially significant in the now and the next of the analytic hour-that is,

This paper is about a central and mostly overlooked aspect of the unconscious as manifested in the clinical work of psychoanalysis. This is its proleptic nature. The unconscious is proleptic in that it performs futural possibilities for the subject. These futural possibilities emerge as potentially significant in the now and the next of the analytic hour-that is,

The eThical FoundaTion oF analyTic acTion We shall give up the idea that there are special classes of processes that prepare or propel mental activity, that is to say, classes that are qualitatively different from the mental activity they prepare or propel; for now everything is an action.-Roy SchafeR (1976, p. 13) An ethics essentially consists in a judgment of our action, with the proviso that [the judgment] is only significant if the action implied by it also contains within it, or is supposed to contain, a judgment, even if it is only implicit. The presence of judgment on both sides is essential to the structure.-JacqueS Lacan (1959-1960, p. 311) A fter Schafer and Lacan, Renik (1993a,b) and Friedman (1993, 2007), and, more or less, the entire relational tradition (Harris 2011), it is by now a commonplace to say that psychoanalysts are interested in their own activity-that is, our activity, what we are doing with our patients, what we, as analysts, say, feel, and imagine. Analysts have grasped the ways in which their internal worlds shape, illuminate, or constrain engagement with, and perhaps the very emergence of, the patient's subjective experience. Analysands talk in the hope we will receive their message generatively, openly, all the while taking the risk that we might misrecognize, not hear, and fail to witness what they want us to recognize, hear, and witness. This risk involves, as Shulman (2016) says, "a bid for utmost intimacy" (p. 706); the emotional stakes are high. In this context, it is no wonder we care deeply about how we act and why we act as we do. This is why what we concern ourselves with is Training and Supervising Analyst, San Francisco Center for Psychoanalysis.

… to preoccupy oneself with the dream-material to the exclusion of a pressing transference re-enactment would merit a certain amount of self-inspection, on the grounds that the seemingly impersonal nature of dream-production may afford the analyst the same respite from unpleasantness as it does the patient (Glover, 1927, p. 505). The starting-point of this paper is Kleinian and the 'street-map' of contemporary schools of psychoanalysis revealed in this paper inevitably reflects this personal view. I start with Klein, and move to the nearest comparisons, other objectrelations views developed in British psychoanalysis.

Psychoanalytic efficacy has been demonstrated in general, but not in comparison with other therapies, nor with detaikd study of the relationship between process and outcome. The steps necessary to accomplish such studies are outlined, along with a review of our present readiness. Crucial dimensions of such work are ex plored, including the use of singk case studies, and ways of looking at sequences of interaction between analyst and patient as they change during various phases of treatment. Methods of using control and comparison groups and follow-up studies are de scribed, and various promising specific strategies are proposed.

Analysis occurs when the space of meeting becomes the place of encounter. This place is no ordinary place, it is a place dedicated to the analysand appropriating her/his own, authentic possibilities of being. The place and process which is analysis is evoked in several ways: by the presence of analyst and analysand, the 'rules' which guide the process and the ambiance of the setting. The last of these includes the use (or not} of the analytic couch. Drawing on qualitative research into several analysts' lived experience of having an analys and use the couch this paper discusses the role of the couch in constituting intersubjective privacy and some of the ways in which the couch contributes to a particular way ofbeing-together-with, bodily attunement, the emergence of an analytic third, and reverie.

By discussing a treatment characterized by its difficult ending, the author strives to show the dynamic impact of separation on phenomena that can be seen as 'telepathic'. Led to develop some inalienable attachment to her analyst in the primary transference, the analysand found herself caught up in the contradiction of her visceral dread of dependency, which compelled her to interrupt the work in progress. She then began to work out her analyst's comings and goings and to run into him in public places, as if to be assured of his immovability. This phenomenon arose with high frequency as the effect of some idealization of the maternal object aiming to deny the spatiotemporal gap. The chance that the experience of rejection via indifference may be repeated also entailed the transferential unfurling of a fantasy involving a double, undifferentiation counterbalancing the lived experience of separation. Furthermore, a 'telepathic' dream occurred as confirmation of this twin relationship which illustrates the analysand's refusal to renounce her narcissistic object. Projective identifications, agglutinated ego nuclei along with primitive cross-identifications could, among other concepts, account for such phenomena which are projective in nature yet real all the same. Such mechanisms could have the power to relay thoughts the moment undifferentiated parts of the egoif not unborn parts of the selfwere activated in a potentially symbiotic zone. Marked by a feeling of dispossession, the analyst's countertransference not only seemed to underscore this hypothesis, it also gave a partial explanation for it. Until the analyst could recognize his own nostalgia for a symbiotic relationship, he had to encourage the occurrence of those unexpected meetings which stemmed from a convergence between the transference and the countertransference.

Abend' s paper is a gift for any author wanting a summary of where conflict theory (sometimes called "classical theory" by those who don' t embrace it, much to the annoyance of those who do and hear, in the word classical, the innuendo of old and outdated) stood on the question of countertransference thirty years ago, to be used as a launching pad from which to discuss developments in how we have been writing about it since then. His writing is clear and unambiguous (or as unambiguous as one could hope for, in the face of continued confusion/debate about such fundamental topics as the therapeutic action of psychoanalysis or how the mind works-especially unconsciously). Since then, the literature on countertransference wrestled with the problem that, while having a certain feeling at a specific moment can be treated as a fact, analysts, as is also true for patients, must interpret that feeling; and then analysts must make clinical choices about how to use their interpretations of their countertransference emotional experiences, and must also make clinical choices about how to respond to analysands' interpretative readings of their analysts.

The author presents two clinical vignettes involving the deliberate use of humor by the analyst, which appeared to help foster an atmosphere that promoted the analytic process. It is suggested that the analyst's use of humor conveyed information about his mental state and his attitude toward the patient which disconfirmed inhibiting expectations and thus increased the patient's ability to be self-reflective and to face painful affects. The potentially deleterious effects of humorlessness in the analyst are also discussed. Among the fondest memories many people have of their analyses are of those moments when their analysts made a joke or expressed their sense of humor. Moments of humor are often important among those experiences of one's analyst's "humanness" and can become markers for the patient of the alliance and sense of partnership that were enjoyed. These expressions of humor from the analyst have multilayered meanings for the patient. They can screen out painful affects in both parties and thus reinforce resistances, or they can help deepen the analytic process and promote healthy growth in the patient. My purpose here is to attempt to understand the instances in which the analyst's expression of humor has efficacious results in the analytic work.

Psychoanalytic therapists are today far more aware of countertransference effects, intersubjectivity, and mutual influence. The area that has been explored least in this two-person appreciation of psychoanalytic process is the effect of the psychodynamics of the therapist in a wide sense-that is, how the therapist brings a whole psychology, with a wide array of potential transferences, to each treatment. Triggered by the unexpected announcement of a patient's expecting a baby, the author reviewed his practice and found that a large portion of his women patients ages 30-45 had become pregnant during therapy or psychoanalysis. The particulars were varied: how much the patient wanted a baby, whether the treatment was psychotherapy or psychoanalysis, the patients' personality structure. Was the analyst's psychology a common factor? The paper presents three quite different case examples and examines whether and how the author's developmental and inner experience of women, sexuality, pregnancy could have contributed to a dyadic process that, in turn, could lead to pregnancy. If such effects happen, then it is important to look beyond and behind "anonymity" and "neutrality," as well as momentary countertransferences, to the real-life effects that we have in our treatments. 1 A very rough review of my practice suggests that more than one third of the patients in the possible group got pregnant during treatment, and another third had a child subsequently (letting me know), for a total of two thirds of the total. My impression is also that this proportion increased to roughly half, as my practice continued, and I saw more women in the latter part of the child-bearing years (ages 30-45). As a baseline comparison, the average child-bearing rate for the age group 30-45 in recent years is 5.5%/year. If my treatment contacts averaged 5 years in length, the "control group" rate would be 28%. My patient population tended to be in the 35-to 45-year-old range, where the "control" rate would be 17%.

Bruce Fink starts his paper by pointing out that there is "no single Lacanian approach to psychoanalytic practice." This is accurate, firstly, because it is unclear what it is to be Lacanian. When in 1980, having dissolved the institution he had created, Lacan travelled to Caracas to address his South American "pupils," he stated: "I come here before launching my Freudian Cause. You can see how important this adjective is to me. You'll be Lacanian if you want. Me; I am Freudian." (Lacan 1980) In addition, Lacan never defined the canon of an orthodox Lacanian practice as he was discovering it all his life, through experimentations with the Freudian model. On one hand, Lacan practised in different ways when he was a young analyst, a less young analyst and eventually a great master, and with this particular analysand or that one. On the other, he contributed an enormous theoretical edifice, which remained for a long time unwritten. Bruce Fink, humbly but also realistically, suggests that the Lacanian community may shiver at the fact that it is an American analyst who has been granted the prestigious task of writing this paper in the holy journal of the IPA, an organisation that Lacan, once president of the Société Psychanalytique de Paris and training analyst, never wanted to leave. Maybe his own grasp of Lacanian theory is "thought by some in the Lacanian community to be overly direct, transparent, and simplistic … " but what makes him particularly fit to achieve this challenging task is twofold: there is no doubt that he has read Lacan, and he is an outsider. Having "devoted the past 35 years to grappling with and translating Lacan's often difficult work," Fink has not only read a great deal more than most but also had to ponder the meaning of the text. Beyond negotiating the didactic function of its ambiguity, metaphors and jokes, the fruitful digressions about the previous evening's conference somewhere or a veiled reference to a friend's clever and useful comment, translating Lacan's text means settling on a meaning. In addition, a career in American academia placed Fink outside the grip of psychoanalytic institutions and allowed him to say what he wished without too much concern about the impact it could have on his future. The first idea specifically associated with a Lacanian approach in this paper is about the radically different approaches to treating neurosis and psychosis. Fink refers to the Lacanian concept of structure as opposed to what today would be called disorders. People "who have never shown any of the well-known florid symptoms of psychosis, such as hallucinations and delusions" have nonetheless a psyche that tends to externalise and attribute to someone else their own unconscious desires, to expect the other's hostility, or that

A GREAT DEAL HAS BEEN WRITTEN ABOUT the resistances of borderline patients to ordinary analytic process. These patients present the analyst with a variety of therapeutic dilemmas because their ability to form a true working alliance is too often either fragile or non-existent. In everyday analytic work, associations and breaks in associations are understood and then interpreted by the analyst. However, severely disturbed patients are not always able to participate in the analysis of the associative process. Instead, they sometimes spend seemingly endless sessions attacking themselves, the analyst, or analysis itself. They may recount bitter complaints about the quality of their lives with apparently no interest in understanding anything new about the cause of their unhappiness. The analyst's attempts to offer help are met with dissatisfaction or rage. Even when these patients appear to receive help with pleasure, they often return to the next session feeling much worse, unable to connect this reaction to the analyst's intervention or to anything else. Borderline patients may react to even tentative interpretations with intense, uncontrolled aggressive outbursts, suicidal gestures or actions, or by abruptly terminating treatment. They often reject attempts by the analyst to remain neutral or to express empathy. The analyst may thus be left feeling as if all analytic tools have been exhausted (cf. Robbins, 1988) ;. The patient who maintains an intensely and unremittingly hostile stance toward the analyst inevitably evokes strong countertransference feelings. It is generally agreed that an important aspect of the analyst's task involves identifying and containing these

The constructivist/relational perspective has challenged the analyst's emotional superiority, her omniscience, and her relative removal from the psychoanalytic dialogue. It at first appears to be antithetical to treatment approaches that emphasize the analyst's holding functions. In this essay I examine the holding model and its resolution from a relational perspective. I propose that the current discomfort with the holding function is related to its apparent, but not necessarily real, implications. I discuss the analyst's and patient's subjectivity during periods of holding. I believe that the holding process is essential when the patient has intensely toxic reactions to "knowing" the analyst and is therefore not yet able to stand a mutual analytic experience. During holding, the patient experiences an illusion of analytic attunement. This requires that the analyst's dysjunctive subjectivity be contained within the analyst, but not that it be abandoned. Ultimately, it is the transition from the holding position toward collaborative interchange that will allow analyst and patient explicitly to address and ultimately to integrate dependence and mutuality within the psychoanalytic setting and thereby engage in an intersubjective dialogue. The movement toward mutuality will require that the analyst of the holding situation begin to fail in ways that increasingly expose her externality and thus her subjectivity to the patient. An important theme that prevades much recent psycho analytic writing concerns the centrality of the analyst's subjectivity in the therapeutic process. This focus emphasizes the

Objective countertransference comprises those feelings the analyst experiences with the patient that are repetitions of feelings from the patient's life outside the analysis. It is viewed as being induced by the patient,-and is understood in the context of the patient's life, not the analyst's. The concept is used to understand the relationship of some of the analyst's feelings to recurrent interpersonal patterns in the patient's life. It has often been viewed as being incompatible with a two-person psychology. Here, in contrast, it is argued that objective countertransference is only one current within the analyst's total emotional response to the patient, and that it should be conceptualized as a component of a broader two-person psychology. However, the use of objective countertransference as a conceptual tool highlights aspects of the analytic relationship that differ from those emphasized in current two-person models. A case example is analyzed from both perspectives to illustrate their similarities and differences. Although the concept of objective countertransference can enrich the analyst's understanding of certain dimensions of the analytic relationship, it is not a theory of technique and it is not wedded to any particular style of psychoanalytic intervention.

The author talks about the affective clandestinity of a paedophile patient within the analytic relationship. It can be either a patient’s communicative way of his childish world or the result of an unconscious perverse utilization of secrecy. It takes place when a condition that is polysemic, open, changing and potentially rich in meaning becomes a stable condition of splitting, that is to say, a kind of crypt or tomb. The clinical case presented points out the relationship between the continuous shifts of the patient’s figures of clandestinity and the analyst’s countertransferential continuous shifts between containment and refusal.

The article highlights various aspects of presence / absence: in the sense of presence / absence of the bodies during online meetings; in the sense of the presence / absence of mental material during the psychoanalytic session; features of presence / absence during work with non-neurotic patients. The author also emphasizes the special role of the voice as an agent of the psychoanalyst's presence during online meetings. The author illustrates her reflections with short details from two clinical cases in that the transition from face-to-face meetings to online meetings occurred during the lockdown, caused various consequences.

The title of the sixth section of "The Freudian Thing" is addressed precisely to practitioners of the by then (circa 1955) standardized version of post/pseudo-Freudian clinical analysis against which Lacan rebels in the name of a "return to Freud." In particular, this title's target is the analytic focus on "defenses" pioneered by Anna Freud during the later years of her father's life. The "analysis of defenses" comes to be integral to Lacan's ego-psychological nemeses. As I explain what "resistance to the resisters" means elsewhere: In 'The Freudian Thing,' the section 'The Thing Speaks of Itself ' closes with la Chose comme vérité addressing its post-Freudian pursuers, namely, non-Lacanian analysts as Freud's hunting dogs who turn on their master when they finally come upon this Thing as their supposed prey (paraphrasing Jean-Paul Sartre, one might say that, by Lacan's estimation, every non-Lacanian analyst is a dog). La Chose proclaims to them, 'Now that you are already lost, I belie myself, I defy you, I slip away: you say that I am being defensive.' A subsequent section of this same écrit is entitled 'Resistance to the Resisters.' In Lacan's prosopopoeia, the hounds are analysts who permit themselves recourse to an approach relying upon a distinction between, on the one hand, the superficial resistances

During the past three years, the Study Group of Psychoanalytic Epistemology of the SPPA has revised the status of certain concepts (the unconscious, trauma and causality) within the current psychoanalytical theory, in the light of a perspective of complexity. Following our plan of study, we have focused our attention on the topic ‘transference’. Revising articles published in the IJP, it seems that currently this term incorporates, besides Freud’s traditional concept, all the later development in the patient–analyst relationship, raising an immediate question. When we talk about transference, a central concept in psychoanalyses, are we all referring to the same ‘transference’? We can set an example, among many others, from an article written by Thomas Ogden, an author well known in Brazil, published in 2004, The art of psychoanalysis: Dreaming undreamt dreams and interrupted cries. The author’s understanding of the psychoanalytical process, presented in this paper, does not include ...

This book makes the work of one of the most inspiring contemporary French psychoanalysts 1 accessible to the Anglo-Saxon readership. It revisits and expands some of the themes explored in his previous publications. In this review I can only address some of them. Method ⁄ technique The first chapter of the book constituted one of the three previously published texts which were introduced at the 2001 IPA Congress in Nice on the theme 'Psychoanalysis, Method and Applications'. In this seminal and much-celebrated article, Donnet points out the inherent contradiction between the use that psychoanalysts make of the notion of method, linked to the specificity of unconscious psychic processes, on the one hand, and the requirement that analysts from different traditions have of applicable prescriptions. This is discussed later in the book in terms of his distinction between the analytic method and psychoanalytic techniques, and the tension between subjectivity and objectivity. A fundamental paradox persists in psychoanalysis: Any attempt to define the analytic method is faced with the contrast between what the term method suggests in the way of controlled organization, and the renunciation of control implied by free association. This paradox is necessary if the unconscious was to open to rational investigation. (p. 21) This leads Donnet to indicate the contradiction between the necessary, acquired knowledge on the one hand, and the need to suspend knowledge on the other. Concepts of 'learned ignorance' (Lacan) and negative capacity (Bion) are evoked (Chapter 2), as well as Winnicott's distinction between game and play, i.e. between a game with rules and play without rules (p. 6). Donnet quotes from Michael Parsons, who identifies the function of ''guardian of play in psychoanalysis'' that requires an internal activity on the part of the analyst. Donnet suggests that this refers to the superego register.

This article is a review of the international scientific literature on informed consent and its use in some of the constituent organizations of the International Psychoanalytical Association (IPA). Because psychoanalysis comprises a theory based on practice, the dearth of clinical material for study, training and research purposes is a serious problem for analysts. Supervisions, presentations at scientific societies and congresses, publications and teaching material involve patients to an extent that goes beyond the work done in their sessions. Should consent be requested in these cases? This contribution addresses controversial and long-standing issues such as informed consent and confidentiality, audio recording of treatments, knowledge production, the ambivalence of participating subjects over time and the perspective of analysts and patients respectively. The authors consider the various alternative approaches available for the handling of these ethical dilemmas without losing sight of the patient's dignity and personal rights, while also taking account of the position of the analyst.

This critical review of the current disputes concerning countertransference enactment systematically outlines the various issues and the perspectives adopted by the relevant psychoanalytic authors. In the light of this the 'common ground ' hypothesis concerning the unifying influence of contemporary countertransference theory is challenged. While the existence of enactments, minimally defined as the analyst's inadvertent actualization of the patient's transference fantasies, is widely accepted, controversies regarding the specific scope, nature, prevalence, relationship to countertransference experience, impact on the analytic process, role played by the analyst's subjectivity, and the correct handling of enactments abound. Rather than taking a stand based on ideological allegiance to any particular psychoanalytic school or philosophical position, the author argues that the relative merits of contending perspectives is best evaluated with reference to close process scrutiny of the context, manifestation and impact of specific enactments on patients' intrapsychic functioning and the analytic relationship. A detailed account of an interpretative enactment provides a context for the author's position on these debates.

ARCHAEOLOGICAL LISTENING COULD be defined as a manner of listening in which the analyst attempts to derive the unconscious meaning (latent content) of the patient's communications through a process of deciphering the manifest content. The essence of archaeological listening was articulated by Freud (1900) in his method of dream interpretation, which came to serve as a prototype for the interpretation of all aspects of subjective experience, since remembered dreams, like any other form of conscious mentation, were thought to reflect a compromise between the conflicting and unconscious forces within the mind. In this model, conscious experience was presumed to be but a pale reflection of unconscious activity. The unconscious is the true psychical reality; in its innermost nature it is as much unknown to us as the reality of the external world, and it is as incompletely presented by the data of consciousness as is the external world by the communications of our sense organs (Freud, 1900p. 613). The archaeological metaphor is apropos in terms of the topographic model, in that unconscious activity reflects a regression (i.e. a return to the past) when compared with conscious mentation. Freud described three types of regression that may be discerned in unconscious activity: (a) topographical regression, in the sense of the schematic picture of the Ψ-systems which we have explained above; (b) temporal regression, in so far as what is in question is a harking back to older psychical structures; and (c) formal regression, where primitive methods of expression and representation take the place of the usual ones (1900p. 548).