Recurring thoughts on unconscious ego resistances

The significance of the ego in "The Ego and the Id" and its unfulfilled promise

It is not well known that The Ego and the Id, where Freud presented his second model of the mind, and introduced a new role for the Ego, was ignored by many of the major theorists that followed. I will attempt to demonstrate the importance of this new view of the ego for clinical psychoanalysis, and what has been lost by its being ignored.

Transference focused psychotherapy: overview and update

This paper describes a specific psychoanalytic psychotherapy for patients with severe personality disorders, its technical approach and specific research projects establishing empirical evidence supporting its efficacy. This treatment derives from the findings of the Menninger Foundation Psychotherapy Research project, and applies a model of contemporary psychoanalytic object relations theory as its theoretical foundation. The paper differentiates this treatment from alternative psychoanalytic approaches, including other types of psychoanalytic psychotherapy as well as standard psychoanalysis, and from three alternative non-analytical treatments prevalent in the treatment of borderline patients, namely, dialectic behavior therapy, supportive psychotherapy based on psychoanalytic theory, and schema focused therapy. It concludes with indications and contraindications to this particular therapeutic approach derived from the clinical experience that evolved in the course of the sequence of research projects leading to the empirical establishment of its efficacy.

A shadow concept

The author focuses on the significance of preconscious thinking, and its relationship to what we think of as unconscious fantasies. He reopens Freud's forgotten struggle with preconscious thinking, while he explores preconscious thinking as the basis for thinking about psychoanalytic treatment. This includes our goals in bringing an idea to the analysand's attention, and the role of transitional space where thoughts and feelings can be played with.

How can we know what we need to know? Reflections on clinical judgment formation

What distinguishes a psychoanalyst from any other psychologically minded, empathic human being? This seemingly simple question goes to the heart of our profession, the way we see ourselves as competent clinicians. To understand a patient's material beyond ordinary empathy--that is, to come to a clinical judgment--we need to step out of the dyadic, countertransference situation and reflect what we've experienced in reference to our clinical theories. An analytic vignette shows how a theoretical background can be used to understand and interpret to a patient in a way that is deeply meaningful.

Back to the future

Significant components of psychoanalytic technique, and the theory that underlies it, seem to remain buried in our past, but are central to the growth of psychoanalysis as a treatment method based on understanding a patient's mind. By updating technique based on a theory of mind with structure, the author views the increasing freedom of the patient's mind as central to the curative process, and takes the position that in interpretive work, the analyst needs to pay more attention to the patient's capacity to meaningfully receive and integrate the analyst's interventions.

Telling stories

Patients need to tell their stories. One of our primary tasks as analysts is to help patients tell their stories and own them. The freedom of mind to think, to feel, and to know are dependent on the ongoing capacity for storytelling. The analyst's stance plays a major role in the development of the analysand's storytelling capacities.

On trying something new: effort and practice in psychoanalytic change

This paper describes one of the ingredients of successful psychoanalytic change: the necessity for the analysand to actively attempt altered patterns of thinking, behaving, feeling, and relating outside of the analytic relationship. When successful, such self-initiated attempts at change are founded on insight and experience gained in the transference and constitute a crucial step in the consolidation and transfer of therapeutic gains. The analytic literature related to this aspect of therapeutic action is reviewed, including the work of Freud, Bader, Rangell, Renik, Valenstein, and Wheelis. Recent interest in the complex and complementary relationship between action and increased self-understanding as it unfolds in the analytic setting is extended beyond the consulting room to include the analysand's extra-analytic attempts to initiate change. Contemporary views of the relationship between praxis and self-knowledge are discussed and offered as theoretical support for broadening analytic technique to include greater attention to the analysand's efforts at implementing therapeutic gains. Case vignettes are presented.

What is a deep interpretation?

Important differences are emerging regarding the place where analysts believe the most meaningful analytic work takes place. One area that highlights these distinct ways of working is the analyst's view of deep interpretations. Models underlying the differing perspectives on this issue are presented, along with an extended clinical example that illustrates the importance of considering, in formulating analytic interventions, the concept of a structured mind. A view of the analytic process that accords the patient's perspective greater privilege is introduced.

Superego defense analysis in the termination phase

This paper is a contribution to recent efforts to identify areas in clinical theory and practice in which the analyst's authority is used, rather than analyzed, to achieve therapeutic results. In the termination phase there may occur an intensification of transferences of authority (superego transferences) in response to the aggression inherent in termination. Analysts may develop counterresistances to analyzing these defense transferences, since their analysis exposes the analyst to the patient's heightened aggression at termination. The literature on termination may have contributed to analysts' falling short in analyzing these transferences, by its having accorded internalizing mechanisms a prominence in the therapeutic action of termination that they otherwise lack in contemporary ego psychological theories of therapeutic action. Gray's formulation of the superego as an analyzable defensive activity is applied to events in the termination period, thereby bringing into focus conflicts over aggressive impulses defended against by superego forces. Clinical vignettes from the termination phase of an analysis are presented.

The triangle of clinical judgment

There are always third elements intersecting the analytic pair. One such element is the analytic community. The analyst is therefore never in a dyadic relationship with the patient, but always in a triangle. In relation to the patient, the analyst will be concerned with useful practices. In relation to the analytic community, the analyst will be concerned with consensually approved principles. This tension is constant in analytic work and in the analytic literature.

Understanding the patient's use of the method of free association: an ego psychological approach

While most of our methods of listening have been geared toward unearthing unconscious fantasies, those directed toward the ego's all-inclusive role in effecting the associative process have lagged far behind. It is the thesis of this paper that listening from the perspective of the ego allows the analyst to work more closely with what the patient is ready to understand. Clinical technique, using an ego psychological view, is elaborated, demonstrated, and compared to technique dependent on the reading of signs and symbols of the unconscious.

The ego and its significance in analytic interventions

Freud's view of the ego as Januslike, the one component of the psychic system turned toward the external world yet partly unconscious, should have insured its centrality in clinical interventions. However, history and experience do not bear this out. It is argued that a core part of the change process in analysis lies in the modifications that occur in ego functioning, making it necessary to carefully consider the role of the ego in clinical technique. Numerous clinical examples are presented to show the manner and significance of such an approach.

Emerging indicators of ego growth and associated resistances

In this paper the technique of resistance analysis is extended beyond a focus on defenses against aggressive drive derivatives to include a focus on resistances based on libidinal conflicts and resistances which stem from defenses against accessing and using autonomous ego functions. For example, patients may resist progress by forming primary defenses against expression of joyful affects, increased capacity to think, and/or new possibilities for effective action. This expanded focus for analysis of resistance permits us to build a technique bridge between drive-defense perspectives and ego psychology, it highlights the need to analyze the sense of danger involved in autonomous ego functioning, and it points to a way of freeing such functioning from the influences of resistance.

Beginning a psychoanalytic treatment: establishing an analytic frame

The opening phase of analysis has received scant attention. Freud initially included, as essential, the establishment of an analytic process via the method of free association in the opening phase. However, his stance in relation to this process we can now characterize as authoritarian, and as influenced by suggestion and manipulation. Recent literature, while contributing to the understanding of the range of dynamics possible when beginning an analysis, continues to ignore the manner in which the method of free association may be used by both participants in establishing an analytic frame. Two clinical examples of how this latter process may be inaugurated are given, and reasons for the drift away from it are suggested.

Resistance analysis and psychic reality

The purpose of this paper is to elucidate some aspects of our mode of working; how we as analysts listen, observe, and collect information to formulate appropriate resistance interventions. Analytic exploration and technique should to a greater extent than what is usual include a careful analysis of verbal and nonverbal resistance expressions, as these may contain important material related to the analysand's psychic and historical reality. Our theoretical and technical conceptualization of how a systematic and consistent resistance analysis is performed should be improved. Our listening and observing attitude involves the simultaneous use of various forms of auditory, visual, and enactive data. This is exemplified by an excerpt from an analytic hour in which a specific resistance problem--an analysand's suppressed response to crying--is examined and linked to specific preverbal experiences.

On focused association and the analytic surface: clinical opportunities in resolving analytic stalemate

Focused association is a technique for exploring repetitive noncommunicative phenomena, especially those which occupy center stage during periods of analytic stalemate. This psychological content is studied by a two-part investigation of the particulars of the presenting "surface," involving (1) focusing and (2) association. The technique was originally devised by Freud to access the latent meanings of dreams. The effort departs from free association, calling upon more active analytic teamwork within a transference-countertransference context that is steadily considered and analyzed. The key "unverbal" material arising from this dyadic flux is descriptively preconscious, multimodal, widely variable in form, and not primarily lexical. A frequent finding is that these repeating ad hoc clinical phenomena, often categorized as resistance (especially transference resistance), are highly condensed and defensively rearranged compositions, like dreams, that have been internally structured by processes akin to dreamwork. Approached by focused association, such content yields unconscious derivatives that previously had been sequestered in repetitious, noncommunicative forms. This work allows the analyst to follow Freud's clinical maxim to "start with the surface" and provides relief for the analyst from the temptation to invoke global resistance interpretations when derivative communication and analytic movement have lapsed.

Do actions speak louder than words? A query into an enigma in analytic theory and technique

While action is increasingly viewed as ubiquitous throughout psychoanalytic treatment, our understanding of why it occurs is limited by rudimentary views of verbalization and action. Dynamic and genetic interpretations of action, usually given at a time of resistance impasse, give only a partial explanation of the phenomenon. The question is explored of why the behavior may appear in the form of action, as well as its implication for interpretive strategies. A major premise is that the role of the ego has been overlooked, especially modes of thinking associated with earlier developmental levels.

Some ambiguities in the method of free association and their implications for technique

The method of free association, rooted in the topographic model, has not been clearly defined in structural terms. Little changed since Freud; the method is geared toward overcoming rather than investigating resistances. Furthermore, it is designed to discourage rather than encourage self-analysis. This seems to be another example of a "developmental lag" in adapting the psychology of the ego to clinical technique.

Postoedipal transformations: latency, adolescence, and pathogenesis

There is a tendency in psychoanalysis to seek ever earlier determinants of pathology. One effect of this search is to relegate adult memories of latency and adolescence to serving mainly a defensive screen function. Psychoanalytic material from child and adolescent cases is used in this paper to illuminate postoedipal developmental transformations. These findings are applied to the understanding and technique of work with adults. Alertness to latency elements can affect the timing of interpretations, the understanding of neurosogenic factors, and the forces for health available in the patient's personality. Alertness to adolescent phenomena highlights the adult patient's difficulty in integrating adolescent realities with childhood fantasy solutions to preoedipal and oedipal conflicts. We conclude that no one phase has preeminence over others, that earlier is not necessarily more important, and that there cannot be pure recapitulation, revival, or "reanimation" (Freud, 1925) of the past in the present. However, knowledge of the transformations appropriate to each phase in the past gives us additional access to the determinants and functions of the patient's pathology in the present, increases the specificity of genetic interpretation, and gives both patient and analyst greater conviction about the accuracy of the essential analytic work of reconstruction.

"In the neighborhood": aspects of a good interpretation and a "developmental lag" in ego psychology

The significance of the conscious ego in the interpretive process has increasingly come under scrutiny. It is becoming clearer that the analyst's view of the conscious ego orients his interpretive approach, and subtly sets the goals of the analysis. At various times Freud championed the analytic importance of the conscious ego, and alternately rejected its significance. Hartmann's view of the ego stimulated research into a developmental line of the ego, while investigations of the ego in clinical psychoanalysis lagged far behind. The importance of the conscious ego in understanding resistances and levels of communication are explored.