Memory and therapeutic action

Psychoanalytic proof: Revisiting Freud's Tally Argument

This paper explores the notion of proof in clinical psychoanalysis by reconsidering an argument Freud made concerning the relation between successful psychoanalytic treatment and truth, dubbed the "Tally Argument" by the philosopher Adolf Grünbaum. I first reiterate criticisms of Grünbaum's reconstruction of this argument, which bring out the degree to which he has misunderstood Freud. I then offer my own interpretation of the argument and the reasoning that underlies its key premise. Drawing from this discussion, I explore three forms of proof, each inspired also by analogies with other disciplines. Laurence Perrine's "The Nature of Proof in the Interpretation of Poetry" stimulates my discussion of inferential proof, the relevant form of which involves proving an interpretation through a strong enough Inference to the Best Explanation. Mathematical proof stimulates my discussion of apodictic proof, of which psychoanalytic insight is a fitting example. Finally, holism in legal reasoning stimulates my discussion of holistic proof, which provides a reliable means by which therapeutic success can verify epistemic conclusions. These three forms of proof can play a crucial role in ascertaining psychoanalytic truth.

Seeing the past in a new light: change in reports of childhood abuse and neglect before and after inpatient psychotherapy and its relevance for change in depression symptoms

OBJECTIVE

As changes in mental representations have been discussed as mechanisms of change in psychotherapy, the question arises whether recollections of childhood abuse and neglect are altered as well and how they relate to symptom changes.

METHOD

Individuals in psychosomatic inpatient treatment (N = 488, 60.5% women) filled out the Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-9). Changes in both were investigated with correlations and t-tests. Linear regression analysis was used to test whether CTQ changes predicted symptom changes. Network analysis was performed to ascertain structural connections between somatic and emotional-cognitive depression symptoms and CTQ subscales before and after treatment.

RESULTS

After treatment (duration in days: M = 52.83, SD = 20.94), patients reported fewer depression symptoms (d = 0.84), while CTQ scores increased slightly (d = 0.11). Changes in the CTQ predicted recovery from depression symptoms in a statistically significant way (β = .133, p = .001). We did not observe changes in the overall network structure between baseline assessment and discharge.

CONCLUSION

The findings suggest that the evaluation of past experiences can change over multiple weeks of psychotherapy. Further, these updated mental representations, indicating a greater recognition of past adversity, may contribute to symptom relief.

Remembrance, trauma and collective memory: The battle for memory in psychoanalysis

In contemporary clinical theory in psychoanalysis, remembering life-historical events and reconstructing the past have lost the central therapeutic function that they had for Freud. The author describes this development and demonstrates the way in which trauma and its remembrance resist it. He discusses the problem of the truth status of memories. Traumatic memories are not subject to transformation by the present when they are retrieved. They constitute a kind of foreign body in the psychic-associative network, but rather than forming an exact replica of the traumatic experience they undergo specific remodellings. The author describes some of the psychic processes in this encapsulated realm. Resolving its predominant dynamics and extricating phantasy from traumatic reality require a remembrance and reconstruction of the traumatic events in the analytic treatment. The author goes on to describe the vital importance of social discourse concerning historical truth for both the individual concerned and society in connection with disasters defined as man-made. A reluctance to know often sets in here that stems from the desire to avoid confronting the crimes, the horror and the victims' suffering. With the Holocaust in particular, the further problem arises of how to avoid its subjugation in historical description to defining categories that eliminate the horror and traumatic nature of the events. Remembering crimes unfolds a special set of dynamics. The author describes both these dynamics and their transgenerational effects on post-war German society. He concludes that, in order to confront the problems posed by a multifaceted traumatic reality, it is also necessary to battle to restore memory to an appropriate place in psychoanalysis.

Making conscious the unconscious in order to modify unconscious processing: Some mechanisms of therapeutic change

This paper examines some of the mechanisms through which interpretation aimed primarily at increasing conscious awareness can nonetheless produce unconscious changes, the latter being deemed the basic aim of psychoanalysis. The concept of valency or motivational weight of the interpretation is proposed to assess which forces of the various motivational systems the interpretation mobilizes (hetero/self-preservation, sensual/sexual, attachment, narcissistic, psychobiological regulation etc.), on which of the above-mentioned systems interpretation relies, and which would oppose therapeutic intervention and why. Certain conditions are also analyzed that could explain the so-called 'change through the analytic relationship', pointing out that, despite the major differences between this form of change and change through interpretation, both of them would share certain mechanisms. This conclusion leads to the need to qualify the idea that interpretation would be exclusively aimed at declarative memory, with no effects upon procedural memory. The paper examines the potential consequences for therapeutic techniques derived from recent findings in neuroscience on so-called labile state memory, and proposes the coupling of experiences as one of the analytical instruments used for therapeutic change. A clinical vignette is included to illustrate some of the theoretical and technical aspects considered.

Affect and the therapeutic action of psychoanalysis

In connection with controversial IJP articles by Stern et al. and Fonagy on the interpretation of the repressed and the recovery of past memories, the author maintains that the affect that is inherent in positive transference is at the heart of therapeutic action. Points of view put forward in the controversy (based on neurobiological knowledge) are related to Freudian metapsychology, as well as to their precursors whose scope was necessarily limited by a lack of access to more recent scientific discoveries. The author demonstrates metapsychological elements of therapeutic action inherent in the intersubjective relationship, especially identification, manifested in introjection and empathy. He describes cognitive development as spontaneously blossoming from the affective nucleus, and he explains the neuroscientific bases of this step forward. The classic (interpretative) psychoanalytic method makes up the cognitive superstructure necessary for the organisation of the mind that has sprung from the affective substructure. As a primary factor in psychic change, interpretation is limited in effectiveness to pathologies arising from the verbal phase, related to explicit memories, with no effect in the pre-verbal phase where implicit memories are to be found. Interpretation--the method used to the exclusion of all others for a century--is only partial; when used in isolation it does not meet the demands of modern broad-spectrum psychoanalysis, as the clinical material presented illustrates.

WHEN IS TRUTH RELEVANT?

The authors argue that the experience of knowing and having the truth about oneself known in the context of therapy is not an end in itself; rather, it is important because the trust engendered by this experience (epistemic trust or trust in new knowledge) opens one up to learning about one's social world and finding better ways to live in it. The authors consider the consequences of a lack of epistemic trust in terms of psychopathology.

The case for neuropsychoanalysis: Why a dialogue with neuroscience is necessary but not sufficient for psychoanalysis

Recent advances in the cognitive, affective and social neurosciences have enabled these fields to study aspects of the mind that are central to psychoanalysis. These developments raise a number of possibilities for psychoanalysis. Can it engage the neurosciences in a productive and mutually enriching dialogue without compromising its own integrity and unique perspective? While many analysts welcome interdisciplinary exchanges with the neurosciences, termed neuropsychoanalysis, some have voiced concerns about their potentially deleterious effects on psychoanalytic theory and practice. In this paper we outline the development and aims of neuropsychoanalysis, and consider its reception in psychoanalysis and in the neurosciences. We then discuss some of the concerns raised within psychoanalysis, with particular emphasis on the epistemological foundations of neuropsychoanalysis. While this paper does not attempt to fully address the clinical applications of neuropsychoanalysis, we offer and discuss a brief case illustration in order to demonstrate that neuroscientific research findings can be used to enrich our models of the mind in ways that, in turn, may influence how analysts work with their patients. We will conclude that neuropsychoanalysis is grounded in the history of psychoanalysis, that it is part of the psychoanalytic worldview, and that it is necessary, albeit not sufficient, for the future viability of psychoanalysis.

Analytic change: Assessing ways of being in a psychoanalytic follow-up interview

The article argues that the concepts of relational scenario, structuralized affect and actualized affect are proposed candidates for observation of changes in relational ways of being as it is expressed in transference. A psychoanalytic follow-up interview of a former analytic patient is presented in order to illustrate how change in relational ways of being may be registered and studied. By triangulating the patient's verbal report of change with nonverbal information and transference-countertransference dynamics, one may grasp qualitative changes in relational ways of being. The case presented illustrates a former patient's on-going process of working towards representing aggression in a more direct manner and how this process is made observable with the aid of the proposed concepts in the interview situation. The proposed concepts of relational scenario, structuralized and actualized affect discussed are compared to the concept of transference used in studies of core conflictual relationship theme (CCRT).

Repression and splitting in the psychoanalytic process

The authors examine the concepts of repression and splitting and their interplay during the psychoanalytic process. Initially, repression was introduced by the clinical phenomenon of resistance, leading to the formulation of the association between intrapsychic conflicts and neurotic symptoms. Later, repression was linked to normal development and to personality organization. Splitting, on the other hand, has been defined in quite diverse ways. The two main definitions are of splitting within the ego, and splitting of representations of the self, and of internal and external objects. Repression and splitting are compared developmentally, dynamically, and with respect to their relationship to psychic functioning and energic conditions. Clinical material is presented from the analysis of a patient who presented with borderline personality organization and narcissistic features. During the initial phase of analysis, splitting associated with projection, projective identification and idealization were the main defence mechanisms. As the analysis progressed and the themes of omnipotence and mourning were explored with the simultaneous working through of drive derivatives expressed in the transference, repression gained ground over the more primitive defence mechanisms. The evolution of the case showed a gradual shift from splitting to repression and the association of repression with a more advanced psychic organization. This development reflected the dynamic movement from borderline to hysterical organization in psychoanalytic nosology.

The meaning of a metapsychology as an instrument for "explaining"

The author points out how some psychoanalytical concepts that were considered as fundamental and unchangeable are actually changing. Child Psychoanalysis with its "infant psychoanalysis" (babies and parents) and other psychological sciences have contributed to this development. Nevertheless, many psychoanalysts have not taken this new knowledge into account. The author ascribes it to the lack of an epistemological distinction between "describing" (facts) and "explaining" (hypotheses), that is, between what are known as discoveries in psychoanalysis and what are theories instead. No theory can be a discovery but rather a hypothetical conceptual instrument trying to explain discoveries. Freud's Metapsychology is a hypothetical instrument which needs to be changed today, since the progress of psychoanalysis and other sciences allows for better instruments. The author wishes for studies which may outline other explicit metapsychologies that may better explicate what is being observed.

One-person and two-person conceptions of attachment and their implications for psychoanalytic thought

There has been increasing interest among analysts in the possibilities of enriching psychoanalytic thought through fuller incorporation of attachment theory and research. This paper offers a clinical illustration of the ways in which attention to an attachment perspective can lead to novel and useful ways of addressing the patient's issues. It also presents a number of cautions that it is necessary to be alert to if attachment thinking is to achieve its full potential in advancing psychoanalytic thought and practice. Conceptions of attachment and approaches to its study and clinical use actually vary quite substantially. Some are more one-person, static, and categorical. Others are more two-person, dynamic, and focused on the process whereby attachment patterns develop and are maintained over time. This paper explores the distinction between these two versions of attachment theory and research with two aims in mind - first, to refine our understanding of the potential role that attachment thinking can play in advancing the psychoanalytic paradigm; second, to utilize the insights achieved through examining the attachment paradigm to consider some broader issues in the construction of psychoanalytic theory more generally and its relational variant in particular.

Dante's Comedy: precursors of psychoanalytic technique and psyche

This paper uses a literary approach to explore what common ground exists in both psychoanalytic technique and views of the psyche, of 'person'. While Western literature has developed various views of psyche and person over centuries, there have been crystallizing, seminal portraits, for instance Shakespeare's perspective on what is human, some of which have endured to the present. By using Dante's Commedia, particularly the Inferno, a 14th century poem that both integrates and revises previous models of psyche and personhood, we can examine what features of psyche, and 'techniques' in soul-healing psychoanalysts have inherited culturally. Discovering basic features of technique and model of psyche we share as psychoanalysts permits us to explore why we have differences in variations on technique and models of inner life.

Reality testing in place of interpretation: a phase in psychoanalytic work with descendants of Holocaust survivors

Repetition of experience endured by the first generation has frequently been observed in descendants of Holocaust survivors. Such repetitions are associated with an erosion of the ability, in the area of the trauma, to distinguish more or less reliably between external and internal reality. This in turn results from the defensive need, in the affected families, to dissociate from such extreme traumatic experiences. Clinical material is presented to show that, at a certain phase in psychoanalytic work with patients belonging to subsequent generations, interpretive activity may need to be temporarily suspended in order to facilitate reality testing and the recognition of the Shoah as an objective historical fact.