Journal of the American Psychoanalytic Association

The extant literature on psychoanalytic methodology scarcely addresses the question as to when, or under what conditions, the psychoanalyst's inner activities of theoretical formulation might be resistive to or facilitative of the psychoanalytic process. These notes are a preliminary exploration of what might be at issue in answering such questions. General problems concerning the status of theorizing in contemporary philosophy of science and in psychoanalysis are reviewed, and some elementary ways in which theorizing activity might govern the psychoanalyst's functioning are discussed. It is suggested that there are currently three radically divergent attitudes toward such activity, and these are depicted as the computational, the engaged, and the cadaverized psychoanalyst. It is argued that these attitudes foster or fixate the psychoanalyst's illusions, and are therefore resistive to the psychoanalyst's radical responsibility to interrogate free-associatively his or her own suppositions and discursive maneuvers.

Freud' papers on technique were written at a time when he could express supreme confidence in the psychoanalytic process, based on his theory of libido. Freud was far less sanguine about the practices of many contemporary analysts; consequently the papers contain far more don't's than do's. From the vantage point of today, these papers portray a transitional stage in psychoanalysis, an age of innocence, in comparison to the complexities of our current view of the interaction between analyst and analysand.

This paper focuses on the phenomenon of nonverbal behavior and its role in analytic practice and in the teaching of technique. The idea is presented that data arising from the nonverbal realm are underutilized both in the clinical situation and in supervision. Some possible reasons for the development of this situation are presented, illustrated by several clinical examples drawn from the author' experiences as a candidate.

The meaning of the "grist for the mill" metaphor has undergone a shift from "analyzing everything" to "everything is analyzable." This is used as a point of departure for exploring some of the multiple, complicated, and often unrecognized ways reality is used defensively by analyst and analysand. The point of view presented is in the spirit of a balancing perspective with regard to current trends in psychoanalysis which emphasize interactions, the analyst' contribution to transference, reality experiences as causation of psychopathology, and the role of the "real" relationship in the mechanism of therapeutic action.

“He too wants to experience realities and despises everything that is merely ‘imaginary’”–Sigmund Freud (1917, p. 368)

A root metaphor for the psychoanalytic therapeutic process is the mother-infant caretaking relationship. This developmental metaphor has assumed a dominant role for some analysts in how the psychoanalytic process and therapeutic relationship are conceptualized. In this paper, a distinction is made between two uses of the developmental metaphor–naïve and informed. The naïve view as commonly applied constrains our view of the unique relationship between analyst and analysand. The informed view takes into account current research in early social development that has emerged in the last decade of empirical studies with infants, young children, and their parents. While the parent-child relationship may be an inexact model for the analytic connection, some of the implications of the former, as they become more clearly understood in the course of careful research, may provide useful information about how change does or does not occur as a result of the analytic process, and how an analytic process needs to be in place in the analysand before that change can occur.

The author has interviewed and reviewed the cases of over 100 patients with a suspected diagnosis of multiple personality disorder (MPD). He finds it clinically useful to think of a continuum of character pathology in which dissociative and defensive altered states predominate. At one end of this continuum is MPD, which he considers a lower-level dissociative character. He redefines dissociation as a defensive altered state, due to autohypnosis, which augments repression or splitting. Depending on the degree of integration of the ego, it may result in a broad range of disturbances of alertness, awareness, memory, and identity. Four vignettes are presented which illustrate a transient hypnoid state, "characterological" dissociation in an upper-level dissociative character, and two cases of MPD, including one emerging in analysis.

“How didst thou make division of Thyself?”—William Shakespeare, Twelfth Night