Like a rolling stone: Psychotherapy without (episodic) memory

People with profound amnesia still retain the capacity to learn about the emotional value of experiences, which is crucial in developing and sustaining interpersonal relationships. In a 2017 paper, we demonstrated for the first time (with patient JL) that transferential feelings develop across the therapeutic process, despite profound episodic memory impairment after medial temporal lesions. This paper reports a second case (GA) of a profoundly amnesic patient in psychotherapy, this time after lesions to the anterior fornix. The work with GA opens issues such as the differences and similarities to the previous case, counter-transference phenomena, and the effects of hyperphagia. The findings make it clear that many phenomena are common to both GA and JL, such as forgetfulness, various types of repetition, the importance of the therapeutic alliance, and the ability to make therapeutic gain. However, there were differences between the cases, for example as regards confabulation, which may relate to either pre-morbid personality or lesion site. The paper also discusses the way in which patients of this type bear the very status of psychotherapeutic work with profoundly amnesic patients. Where others have seen barriers and in principle problems in working with such patients, we see many opportunities.

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.

Unconscious Fantasy and The Priming Phenomenon

This paper is the third in a series of investigations into (1) the nature and development of unconscious fantasy, (2) its place in a contemporary model of mind that, parenthetically, suggests a possible solution to the problem of theoretical pluralism, and (3) its mode of operation in the mind. The aim of these investigations is to update the notion of unconscious fantasy, an indispensable construct in psychoanalytic theories that assume out-of-awareness mentation, and to situate that construct within contemporary views of mental functioning in disciplines such as philosophy of mind, cognitive science, and developmental psychology. At the same time, data accessible only through psychoanalytic work challenge these fields with findings that indicate the need for further investigation. This paper argues that experimental evidence on the phenomenon of "priming" lends support to one of the seminal claims in our field, one frequently attacked as an outmoded shibboleth: that is, that the past matters, whether encoded in declarative or in procedural memory. In common parlance, we are "primed" to respond to some situations in predetermined ways; the past primes us to experience the present in often unique and personal ways. There is evidence too that the priming mechanism and the encoding of subjective experience in declarative and procedural memory operate from very early in life.

Self and time

This article explores the meaning of subjective time and its implications for the understanding of the nature of the self in psychoanalytic terms. Subjective time, the time experience of intrapsychic life, is distinguished from objective time. Its development and evolution in the course of the life cycle are examined, and various aspects of its phenomenology explored. Implications for the understanding of the structure and functioning of the self, especially the combined influence of physiological and environmental processes reflecting the integration of body-mind in the time experience and self-organization are discussed. Some implications for the engagement of the self in the analytic process are suggested, particularly the focusing of therapeutic interaction in the present moment and the implications of the meaning of structural change in reference to the modification of the self-concept through the revision and integration of memory systems in the present interaction between analyst and analysand.

The struggle to listen: continuing reflections, lingering paradoxes, and some thoughts on recovery of memory

This paper offers a further expansion of the author's continuing endeavor to highlight and explore subtle distinctions and lingering paradoxes in how we listen, and to reconsider their profound implications for clinical work and discovery. Several perhaps commonplace clinical moments are used to sharpen illumination on psychic experience that might otherwise remain outside conscious awareness, whether in the domain of the repressed or in other mnemonic realms, such as "implicit" or "procedural" memory. It is suggested that added dimensions of these different levels of memory may, through our struggle to listen, be ultimately knowable.

Gone but not forgotten: declarative and nondeclarative memory processes and their contributions to resilience

Cognitive psychology research challenges traditional psychoanalytic understanding of memory. The memory of facts and events is now referred to as declarative memory. Nondeclarative memory systems, in contrast, process patterns of perception, emotion, and action without representing the past in terms of any consciously accessible content. The author examines the contributions of declarative and nondeclarative memory processes to resilience. Declarative memories can promote resilience through their capacity to evoke soothing emotional responses. Nondeclarative memory processes can foster resilience through underlying the capacity to elicit and maintain supportive relationships. The concept of nondeclarative memory has potential to inform the understanding of essential psychoanalytic phenomena, including transference, countertransference, and enactment.