Language and the psychoanalytic process: psychoanalysis and Vygotskian psychology. II

Level of Vocabulary Development and Selected Elements Regarding Sensory Integration and Balance in 5-Year-Old Girls and Boys

The aim of this research was to assess relationships between the level of vocabulary and selected elements of sensory integration and balance in 5-year-old girls and boys, showing the differences between them. The study group consisted of 290 5-year-old children (172 boys and 118 girls) with different levels of vocabulary development and selected disturbances in sensory integration and balance processes. To evaluate the developmental deficits of speech with regard to vocabulary, the Children's Dictionary Test was used. The Clinical Test of Sensory Integration and Balance was also employed. In our research's overall assessment, 118 children, i.e., 41%, had a low level of vocabulary, while 108 (37%) had an average level and 64 (22%) had a high level. However, the average score of all examined children (3.71 stens) indicates a low level of vocabulary development. Less developed vocabulary skills included the ability to create subordinate words and define concepts. There were no significant differences in the level of vocabulary between girls and boys. We observed disorders concerning selected elements of sensory integration and balance in most of the children, and more often in boys. There were statistically significant relationships between the level of vocabulary and selected disorders of sensory integration and balance; however, they were not unambiguous. Children with the lowest level of vocabulary in overall assessment obtained significantly the worst results in the Clinical Test of Sensory Integration and Balance (CTSIB) open eyes, hard surface test. However, in the closed eyes, hard surface test, the lowest score was obtained by children with a high overall assessment. In turn, in the open eyes, soft surface test, the lowest score was noted for children with average overall assessment. In the complex CTSIB test, the lowest score was achieved by children with low ability to define concepts. The problem of the relationship between vocabulary level of and sensory integration as well as balance requires further research. The demonstrated significant relationships between some aspects of vocabulary level and selected elements of sensory integration as well as balance confirm the need to care for the overall psychomotor sphere of a child.

Mentalization, insightfulness, and therapeutic action: The importance of mental organization

Continuing debates over the relative importance of the role of interpretation leading to insight versus the relationship with the analyst as contributing to structural change are based on traditional definitions of insight as gaining knowledge of unconscious content. This definition inevitably privileges verbal interpretation as self-knowledge becomes equated with understanding the contents of the mind. It is suggested that a way out of this debate is to redefine insight as a process, one that is called insightfulness. This term builds on concepts such as mentalization, or theory of mind, and suggests that patients present with difficulties being able to fully mentalize. Awareness of repudiated content will usually accompany the attainment of insightfulness. But the point of insightfulness is to regain access to inhibited or repudiated mentalization, not to specific content, per se. Emphasizing the process of insightfulness integrates the importance of the relationship with the analyst with the facilitation of insightfulness. A variety of interventions help patients gain the capacity to reflect upon and become aware of the intricate workings of their minds, of which verbal interpretation is only one. For example, often it seems less important to focus on a particular conflict than to show interest in our patients' minds. Furthermore, analysands develop insightfulness by becoming interested in and observing our minds in action. Because the mind originates in bodily experience, mental functioning will always fluctuate between action modes of experiencing and expressing and verbal, symbolic modes. The analyst's role becomes making the patient aware of regressions to action modes, understanding the reasons for doing so, and subordinating this tendency to the verbal, symbolic mode. All mental functions work better and facilitate greater self-regulation when they work in abstract, symbolic ways. Psychopathology can be understood as failing to develop or losing the symbolic level of organization, either in circumscribed areas or more ubiquitously. And mutative action occurs through helping our patients attain or regain the symbolic level in regard to all mental functions. Such work is best accomplished in the transference. The concept of transference of defense is expanded to all mental structure, so that transference is seen as the interpersonalization of mental structure. That is, patients transfer their mental structure, including their various levels of mentalizing, into the analytic interaction. The analyst observes all levels of the patient's mental functioning and intervenes to raise them to a symbolic one. At times, this will require action interpretations, allowing oneself to be pulled into an enactment with the patient that is then reprocessed at a verbal, symbolic level. Such actions are not corrective emotional experiences but are interpretations and confrontations of the patient's transferred mental organization at a level affectively and cognitively consistent with the level of communication. Nonetheless, the goal becomes raising the communication to a symbolic level as being able to reflect symbolically on all aspects of one's mind with a minimum of restriction is the greatest guarantee of mental health.

On an Evolving Theory of Attachment

This paper adds a new dimension to the evolution of attachment and of representation formation in the toddler stage. During rapprochement, under appropriate conditions, symbolic activity begins to take prominence over sensorimotor activity to guide and regulate affective experience. We propose that as the toddler comes to increasingly reorganize early sensorimotor experiences under the influence of language, the mother plays a new and vital role in helping the toddler achieve new and higher levels of organization. The intensity of the toddler's proximity seeking-behavior, as described by Bowlby, takes on a new element in light of the toddler's need for mother as an essential interlocutor who helps him or her to verbally articulate and organize experience. The toddler's need to seek proximity with mother particularly pro- found during the rapprochement phase, serves not only to safe-guard the toddler's physical well-being but to ensure the survival of the child's developing mind. Moreover the mother's failure to respond appropriately during this time to this emerging need for her as a verbal interpreter of experience may result in disruption of the toddler's burgeoning ability to make appropriate use of verbally mediated representations of the world, self and others. This paper discusses the rapprochement stage in light of this new developmental perspective.

Psychoanalysis as poetry

Like psychoanalysis, poetry is possible because of the nature of verbal language, particularly its potentials to evoke the sensations of lived experience. These potentials are vestiges of the personal relational context in which language is learned, without which there would be no poetry and no psychoanalysis. Such a view of language infuses psychoanalytic writings on poetry, yet has not been fully elaborated. To further that elaboration, a poem by Billy Collins is presented to illustrate the sensorial and imagistic potentials of words, after which the interpersonal processes of language development are explored in an attempt to elucidate the original nature of words as imbued with personal meaning, embodied resonance, and emotion. This view of language and the verbal form allows a fuller understanding of the therapeutic processes of speech and conversation at the heart of psychoanalysis, including the relational potentials of speech between present individuals, which are beyond the reach of poetry. In one sense, the work of the analyst is to create language that mobilizes the experiential, memorial, and relational potentials of words, and in so doing to make a poet out of the patient so that she too can create such language.

The talking cure as action: Freud's theory of ritual revisited

Freud made creative use of late Victorian theories of ritual as empty modes of behavior, using the idea of "seemingly meaningless" ritual to offer a compelling comparison with obsessive behavior. However, analytic hours, with their repetitive frame and repetition of unconscious conflicts, have stronger links with rituals than Freud admitted. Recent theories highlight the extensive power of rituals to organize and instantiate models of effective action, especially in terms of the multifunctionality of language. These new theories of ritual offer in turn new tools for understanding the therapeutic action of analytic hours.

History of the unconscious in Soviet Russia: from its origins to the fall of the Soviet Union

Russia accepted the notion of the unconscious and psychoanalysis before many Western countries. The first Russian Psychoanalytic Society was established in 1911. After World War I and the Russian Revolution, for a short happy period, the following psychoanalysts were active: Sabina Spielrein, Tatiana Rosenthal, Moshe Wulff, Nikolai Osipov and Ivan Ermakov. Scholars associated with Soviet ideas participated too, including Aleksandr Luria, Michail Rejsner and Pavel Blonskij. Lev Vygotskij himself dealt with the unconscious. A second psychoanalytical society was set up in Kazan. Unfortunately, at the end of the 1920s, repression dissolved the psychoanalytic movement. Even the word 'psychoanalysis' was banned for decades. Nonetheless, interest in the unconscious, as distinct from psychoanalytic theory, survived in the work of the Georgian leader D. Uznadze. His followers organized the 1979 International Symposium on the Unconscious, in Tbilisi, Georgia, which marked the breaking of an ideological barrier. Since then, many medical, psychological, philosophical and sociological scholars have taken an interest in the unconscious, a subject both feared, for its ideological implications, and desired. Since the 1980s, psychoanalytic ideas have been published in the scientific press and have spread in society. The fall of the USSR in 1991 liberalized the scientific and institutional development of psychoanalysis.

From developmental metaphor to developmental model: the shrinking role of language in the talking cure

Psychoanalysts have invoked infant development diversely to understand nonverbal and unspoken aspects of lived experience. Two uses of developmental notions and their implications for understanding language and the therapeutic action of psychoanalysis are juxtaposed here: Hans Loewald's conception of developmental metaphors to illuminate ineffable aspects of the clinical situation and Daniel Stern's currently popular developmental model, which draws on findings from quantitative research to explain therapeutic action in the nonverbal realm. Loewald's metaphorical use of early development identifies and thus potentiates a central role for language in psychoanalytic treatment. By contrast, Stern and his colleagues exaggerate the abstract, orderly, and disembodied qualities of language, and consequently underestimate the degree to which lived interpersonal experience can be meaningfully verbalized, as demonstrated here with illustrations from published clinical material. As contemporary psychoanalysis moves toward embracing developmental models such as Stern's, it is concluded, psychoanalysts accept a shrinking role for language in the talking cure.

A new model for conceptualizing insightfulness in the psychoanalysis of young children

Traditional definitions of insight fail to take into account the cognitive and developmental limitations of young analysands, who lack the capacity to mentalize. It is suggested that insightfulness be redefined as promoting mentalization in young children. Gaining this key psychological function furthers the internal integration and self-regulation necessary to regain developmental momentum. The central importance of promoting such development in child psychoanalysis suggests that the facilitation of a mechanism for self-understanding, not the interpretation of content, is essential. Insightfulness is facilitated by employing a range of interventions beyond the interpretation of resistance and content, rendering meaningless the distinction between interpretive and relational aspects of the analyst's role.

Ghosts of paradigms past: the once and future evolution of psychoanalytic thought

An example of the psychoanalytic mode of thought is put forward concerning how psychoanalytic theories have historically been constituted and transformed. The model of world hypotheses, characterized by multiple irresolvable truth claims, captures the nature of most psychoanalytic theorizing until about 1970. Each of two world hypotheses--one grounded in intrapsychic conflict (seen when the analyst observes from outside the transference) and the other in interpersonal internalization (seen when the analyst observes from inside the bidirectional interactive processes)--is an autonomous and self-sufficient aggregate. The stance taken by the analyst-observer with respect to the analytic interaction is key to seeing how the two world hypotheses are made manifest in clinical work and in theory. By contrast, the model of competing programs captures the essential nature of most psychoanalytic theorizing since about 1970, and is characterized by the necessity of each progressively evolving through a particular kind of commerce with its neighbors. Such commerce is necessary when a program is in danger of degenerating. In this way of thinking, there is a fundamental tension between classical psychoanalysis adapting to the demands and exigencies of its particular and ever evolving historical niche and simultaneously retaining the core commitments that guarantee continuity. Honoring the forces of progression displaces the quest for truth as a paramount goal of psychoanalysis. A developmental lag in recognizing this transformation has hindered progress toward a comparative, process-centered psychoanalysis.

Metaphors of a bodily mind

Patients' metaphors in analysis may allow access to ineffable experiences. This is understandable, since the mind is a bodily mind, and language is a fully embodied function of this mind. That is, both are dependent for their existence upon the physical body. The ontogenic accumulation of perceived sensory impressions and affective processes far exceeds what can be put into words. Research in cognitive psychology suggests that the active mind functions in such a manner that later perceptions are organized by means of earlier ones. However, since the mind can know only its own representations, it inhabits two ever unknown realms: the external world itself, and the domain of internal unconscious processes that sustain the mind's functions. As a result, the world and the self we know are constructed by the mediation of our bodies. In language also, the active mode by which we perceive, process, and feel makes our understanding of words dependent on previous experience. The fact that the limbic system is activated immediately in the moment of processing experience means that all modalities of representation include an affective valuation. This inevitable processing of information through the mediation of affectively valued bodily perceptions gives the metaphorical function-the human capacity to organize experience and life in metaphoric ways-the ability to create linguistic metaphors that can capture and express otherwise inexpressible psychic experiences. This manner of understanding metaphor has implications for psychoanalytic technique.

A conjoint phase of treatment involving a severely disturbed adolescent boy and his father

A phase of father-son conjoint treatment during psychoanalytic psychotherapy of the son is described. The son, who met descriptive criteria for schizophrenia, felt most alive when planning revenge on his father; the father frantically dwelled on the son to the exclusion of virtually everything but work. The conjoint therapy complemented the son's individual therapy and led to a stable, hence analyzable transference. The outcome was generally positive in a case whose prognosis at the outset had appeared dismal. Questions concerning therapeutic change and clinical technique are raised. The author suggests that others in similar clinical circumstances might consider a phase of conjoint treatment.

The transference and the zone of proximal development

The Zone of Proximal Development (ZPD) is discussed, a construct that, when introduced into psychoanalysis, advances understanding of the key clinical relationship between the intrapsychic and the interpersonal. Strands from several psychoanalytic formulations are brought together and forged into a coherent construct, which is then contrasted with the transference. It is shown how the ZPD provides the transference with its mutative potential. Just as the transference provides the motivation for the recruitment of objects to accomplish its purposes (repetition), the ZPD leads to the recruitment of objects in order to accomplish its purposes (to learn by ushering individuals into a speech and internalization community). Under the sway of the transference objects are sought so that early disregulating experiences can be repeated and an opportunity provided for a better resolution. The ZPD works in tandem with the transference, capitalizing on the impetus provided, allowing for the possibility of internalization, a beneficial outcome to transference repetition which otherwise would have no agent of conflict resolution. In analysis, when the transference and the ZPD enjoin smoothly, the potential outcome is "insight" in a broad sense. The processes of the ZPD define the optimal interpersonal context of psychoanalysis, one that allows the intrapsychic to be best reached by analytic interventions. Given the inevitability of mutual influences between analyst and analysand, the analyst strives simultaneously to be in the ZPD yet outside the transference with the analysand, a crucial tension that is a constant, precarious technical factor. This useful tension casts light on such procedural guides as optimal frustration and abstinence.

Affectivity in cocaine and opiate abusers

Psychoanalytic theorists concerned with substance abuse suggest that the affect tolerance and affect expression of addicts are impaired due to preverbal influences. However, psychoanalytic contributions have largely been limited to clinical speculations and case study reports. The present study investigated the hypotheses that opiate abusers will demonstrate more impaired affect tolerance and affect expression than cocaine abusers, and that both groups would appear more impaired than a sample of normals. To investigate these hypotheses, a recently developed instrument, the Epigenetic Assessment Rating System (EARS), was employed. The EARS empirically measures verbal and preverbal phenomena theoretically linked with stages of development. The subjects were 25 opiate, 25 cocaine abusers, and 25 normals, matched according to age, gender, and SES criteria. Results supported the hypotheses that opiate and cocaine abusers' affect tolerance and affect expression were significantly impaired as compared to normals. Although affect tolerance did not distinguish between opiate and cocaine abusers, affect expression did. Cocaine abusers were less impaired than opiate abusers by preverbal modes of affect expression, although under stress cocaine abusers regressed to similar states.

An investigation into some implications of a Vygotskian perspective on the origins of mind: psychoanalysis and Vygotskian psychology, Part I

The Russian psychologist Lev Vygotsky proposed an analysis of language, thought, and internalization that has direct relevance to the current concerns of psychoanalysts. Striking methodological and conceptual similarities and useful complementarities with psychoanalysis are discovered when one peers beneath the surface of Vygotskian psychology. Our adaptation of Vygostsky's views expands upon Freud's assigned role to language in the topographic model. We suggest that the analysand's speech offers several windows into the history of the individual, through prosody, tropes, word meaning, and word sense. We particularly emphasize Vygotsky's views on the genesis and utilization of word meanings. The acquisition of word meanings will contain key elements of the internal climate present when the word meaning was forged. Bearing this in mind, crucial theoretical questions follow, such as how psychoanalysis is to understand the unconscious fantasies, identifications, anxieties, and defenses associated with the psychodynamics of language acquisition and later language usage. We propose that the clinical situation is an ideal place to test these hypotheses.