Psychoanalytic Quarterly

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Questions concerning analysts' publication of material from the analyses of their patients have troubled the field of psychoanalysis since its inception. Disguise inevitably distorts the clinical material and is often insufficient to protect the patient from recognition. Asking the patient's consent for publication intrudes upon and alters the analytic process. While analysts have largely reached a consensus about the need for anonymity in published material, there is still considerable debate about the necessity for obtaining patients' consent when using their material for publication...

We propose to critically evaluate and strengthen the level of clinical evidence in psychoanalysis, using a strategy of triangulating clinical phenomena from different perspectives and increasing contextual knowledge. Insufficient discussion of alternative hypotheses and limited contextual information are two Achilles heels of psychoanalytic case presentations. We examine the concept and quality standards of clinical evidence in psychoanalysis and related disciplines, with particular attention to the contribution of the three-level model (3-LM)...

This paper plays with the possibilities of writing about psychoanalytic work in different ways with different levels of disclosure about both patient and analyst. Various issues around anonymity, confidentiality, consent and identity are explored, highlighting the many questions that come up. These issues of how to write psychoanalytically are also addressed from the point of view of culture and the sociopolitical gestalt of our time.

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This paper explores the intricate nexus of writing and psychoanalysis by addressing a key question: In what and how many directions should analytic writing be ethical? The author structures the argument across three axes. First, in an introduction, writing's role as a psychoanalytic invariant is emphasized. Then, an exploration ensues, delving into writing as praxis, navigating complex technical choices, from micro- to macro-perspectives in clinical vignettes, their autobiographical essence, their relevance as models for theory, self-revelation, etc...

The belatedness of analytic writing and its effects on analytic processes are explored through the concepts of nachträglichkeit and thirdness . The temporal gap between being with and writing about functions as a meaningful pause filled with opportunities for investigating unconscious pathways to the analyst's countertransference. The significance of analytic narration in affecting specific psychoanalytic developments is explored. The theoretical framework utilizes the concept of après coup , which brings to light new meanings in an afterwardness of time...

The author describes and then clinically illustrates what he terms the ontological dimension of psychoanalysis (having to do with coming into being) and the epistemological dimension of psychoanalysis (having to do with coming to know and understand). Neither of these dimensions of psychoanalysis exists in pure form; they are inextricably intertwined. Epistemological psychoanalysis, for which Freud and Klein are the principal architects, involves the work of arriving at understandings of play, dreams, and associations; while ontological psychoanalysis, for which Winnicott and Bion are the principal architects, involves creating conditions in which the patient might become more fully alive and real to him- or herself...

In 1930, Melanie Klein published an article presenting the case of Dick. Within the framework of the psychoanalytic technique adapted to the clinical treatment of autism, this article contributes elements to a question posed by many psychoanalysts: why did Klein's interventions affect Dick? To that end, Klein's first intervention is divided into two phases: a first naming phase, consented to by Dick; and a second interpretation phase, triggering detachment from the object, anxiety, and stereotypy. The proposal is to understand the emergence of anxiety in the relationship that the second-phase interpretation has with the first phase of naming...

This paper details my psychoanalytic process evaluating refugees as part of their application for asylum. It focuses on the emergence of unrepresented content and abject states within the intersubjective matrix that lead to collaborative creation of a story of trauma. Such intra- and inter-personal encounters are structured by the larger social, political, and cultural contexts that support, limit, structure, erase, and determine what can be known and told. Knowledge of traumatic inscription necessitates attunement to nonverbal affective states in both survivor and witness as well a receptive society that is able to tolerate grief, acknowledge the degradation and depravity unleashed in victim and victimizer during violence, and absorb survivors' mournful morality tales...

The author investigates bodily aspects of the defense organization in the treatment of a soldier suffering from a war traumatization. The patient reports two situations-a bomb attack and the subsequent confrontation with wounded comrades-that had a traumatizing impact. In the treatment process, a phase of stagnation is described before the shared attention is focused on the bodily perception of the patient. His petrified body feeling ("my body feels like concrete") was systematically examined in the therapeutic process then slowly transformed through shared perception, leading to a process of vitalizing reorganization...

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Weaving subjective musings with theoretical speculation, this paper explores various themes on the question of identity. I consider identity as identification with a social location, where that social location is a function of groups. As such, identity is inherently contingent, a relational affair, a soft assembly. Though not a particularly psychoanalytic concept, identity is currently being tasked with considerable work in psychoanalysis: functioning as a hinge between the dual registers of the personal and social unconscious...

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This paper aims to describe the processes of construction and maintenance of analytic intimacy, understood as a shared state of relative internal freedom that is most permeable to preconscious and unconscious communications, which facilitate the processes of subjectivation, dreaming, and digestion of unprocessed trauma. The author illustrates the theoretical and technical features related to the concept of intimacy, highlighting the transformations of a clinical case followed in supervision. This article is presented in the form of a conversation with the supervisee, so as to evoke in the reader the dialogic and co-constructive experience of thought construction...

When we are confronted with the challenge of trying to fully convey or describe something about human life and emotional experience, we find ourselves up against the very limitations of language. This problem becomes especially relevant as we attempt to expand psychoanalytic theory so as to enable us to "approach a mental life unmapped by the theories elaborated for the understanding of neurosis" (Bion1962, p. 37). This paper seeks to aid in that expansion by revisiting Bion's early writings about the beta screen, extending his conclusions about communication from the psychotic part of the mind to the broad area of the unrepresented (the unstructured unconscious), suggesting that there is often a potentially communicative meaning, a mute plea for intersubjective regulatory assistance (alpha function), embedded in the unconscious evocation of emotions in the object and that this cry for help may be encrypted in even the most seemingly destructive, resistant and oppositional patients...

I use the clinical example of a traumatized adolescent to talk about how a transference experience creates the frame where the analytic work occurs. Out of the external boundaries of the relationships with an object, the internal frame, the womb of transformation processes, is created. The analyst's capacity to wait is essential for the transformation that creates and shapes the transference experience, which, like playing, becomes the matrix of the frame where it happens as it happens. As the traumatic experiences find their place in the transference and begin to be integrated, the adolescent becomes more present and real in the session...

We explore the interpersonal origins of human culture, arguing that culture emerges as a necessary consequence of our helplessness in infancy, which in turn requires a greater degree of collaboration and social organization than is necessary for other mammals. We propose a model of cultural transmission that depends on a dyadic interpersonal process whose vicissitudes can have a lifelong impact. We explore the role played by imagining subjectively experienced psychological states and processes in others, which we have defined as mentalizing , in the process of cultural transmission, and propose that mentalizing is key to the establishment of epistemic trust-that is to say, an experience of trust that enables the individual to absorb and use the knowledge they are being offered...

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