The Process of Case Writing: A Fourth Pillar of Analytic Training

The educational and clinical effects of the process of case writing during analytic training have not been extensively studied, even though the case report, as a product, has prompted attempts to make it a more revealing and accurate document. Countertransference experiences during an analysis can constrain both the candidate's writing and the analytic work, while examining them during the writing process can deepen the candidate's analytic work. Three overlapping resistances to the writing, and their underlying anxieties, are described. These are publication resistances: concerns about the anticipated reception of the candidate's work by potentially critical readers; transference resistances: feelings toward the analytic institute that requires the writing; and countertransference or reimmersion resistances: fears of reawakening reactions from the analysis. These can interfere with finding a safe internal space in which to write. Examples are given of writing through of these resistances during case supervision, resulting in more open writing and in a deepening of the analytic work. As the case writing process can have direct and potentially profound effects on the candidate's current and future analytic work, it is proposed that the process of case writing is a fourth pillar of analytic training, in addition to the candidate's personal analysis, case supervision, and didactic seminars.

Interpretation as Hypothesis

Two distinct spaces can be seen as operating in a session-a private one in the analyst's mind, where formulations take shape, and one shared between patient and analyst, in which interpretations are offered. By maintaining a focus on the here and now in the latter space, taking care to protect it from intrusions from the analyst's theory except as hypotheses (in the form of interpretations derived from those formulations) aimed at eliciting unconscious responses that further the analytic inquiry, a basis for analytic work is established that aligns with ordinary scientific processes: theory is generated in the mind of the researcher, and hypotheses derived from it are tested systematically in a laboratory setting. Self-understanding that develops out of such an arrangement can then be seen as based on evidence, minimizing the role of suggestion. This line of thinking is illustrated with excerpts from the beginning of the analysis of a depressed patient. In developing areas of theory, when reliable evidence is particularly important, this way of working holds promise. In this case evidence was systematically gathered that led to the formulation of a model of internal racism.

Accumulating evidence for myriad alternatives: Modeling the generation of free association

The associative manner by which thoughts follow one another has intrigued scholars for decades. The process by which an association is generated in response to a cue can be explained by classic models of semantic processing through distinct computational mechanisms. Distributed attractor networks implement rich-get-richer dynamics and assume that stronger associations can be reached with fewer steps. Conversely, spreading activation models assume that a cue distributes its activation, in parallel, to all associations at a constant rate. Despite these models' huge influence, their intractability together with the unconstrained nature of free association have restricted their few previous uses to qualitative predictions. To test these computational mechanisms quantitatively, we conceptualize free association as the product of internal evidence accumulation and generate predictions concerning the speed and strength of people's associations. To this end, we first develop a novel approach to mapping the personalized space of words from which an individual chooses an association to a given cue. We then use state-of-the-art evidence accumulation models to demonstrate the function of rich-get-richer dynamics on the one hand and of stochasticity in the rate of spreading activation on the other hand, in preventing an exceedingly slow resolution of the competition among myriad potential associations. Furthermore, whereas our results uniformly indicate that stronger associations require less evidence, only in combination with rich-get-richer dynamics does this explain why weak associations are slow yet prevalent. We discuss implications for models of semantic processing and evidence accumulation and offer recommendations for practical applications and individual-differences research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

On the Role of Speech In Psychoanalysis: Revisiting Lacan's "Function and Field"

A number of underutilized concepts in Lacan's "Function and Field of Language and Speech in Psychoanalysis" are examined with an eye to rendering them accessible and practicable to analysts from outside the Lacanian tradition. The concepts of empty and full speech are discussed, along with the notions of the subject of the unconscious, and speaking as itself a mode of intersubjectivity. Attention is afforded the future-oriented mode of psychic temporality that Lacan argues pertains to psychoanalytic practice (that of the future anterior tense, the standpoint from which analysands situate themselves in respect of what they "will have been"). These concepts are then linked to technical initiatives-such as punctuation (the "editorial" role the analyst plays in reference to the analysand's speech) and scansion (the use of suspension, interruption, or cutting to highlight facets of that speech). These techniques can be read as extensions of Freud's fundamental rule of free association insofar as they aim to disrupt defensive ego narratives, engage unconscious processes, and draw analysands' attention, in a potentially transformative manner, to their speech and what it does.

Liquid Modernity and Imagistic Production: Reflections on Social Media and Free Associations

Social media has profound impact on how we experience the world and interact with others. Rapidly advancing technology has created platforms that have become increasingly image-based and emotionally manipulative. Do the new patterns of communication change patients' mental processes? Is free association becoming more imagistic? Contemporary clinical settings invite new perspectives on the intersections between the social and individual realms, patients' modes of expression, and analysts' interpretations.

Social Representations of "Tinnitus" and "Health" among Individuals with Tinnitus Seeking Online Psychological Interventions

(1) Objective: Social representations theory (SRT) is a body of theory within social psychology concerned with how individuals, groups, and communities collectively make sense of socially relevant or problematic issues, ideas, and practices. SRT has been increasingly sued in the area of health and disability. The current study examined the social representations of "tinnitus" and "health" among individuals with tinnitus who are seeking online psychological interventions. (2) Materials/Method: The data were gathered using a free association task about their "tinnitus" and "health" from 399 individuals with tinnitus. The data were analyzed using both qualitative and quantitative analyses methods. (3) Results: The responses resulted in 39 and 30 categories respectively, for "tinnitus" and "health". The most commonly occurring categories for tinnitus included: descriptions of tinnitus (18%), annoying (13.5%), persistent (8%), and distracting (5%). The most commonly occurring categories for health included: content (12%), conditions (8%), active (7%), take control (6%), and overweight (5%). The responses to tinnitus had predominantly negative connotations (i.e., 76.9%) whereas a larger proportion of responses toward their health was related to positive connotations (i.e., 46.4%). These frequently occurring items were also dominant in similarities analysis. Prototypical analysis of tinnitus responses identified categories horrible and bothersome to be key items in the central zone. The categories in central zone of health responses included: content, active, healthy, grateful, and overweight. (4) Conclusions: Individuals with tinnitus have very negative view of their tinnitus impacting their psychological status. Tinnitus management should focus on reducing the negative associations toward their tinnitus and strengthen the positive aspects related to their general health.

Some Arguments About Free Association as a Technique

Freud, early in psychoanalytic history, modified hypnotic technique and recommended, in its stead, free association. This paper takes a close look at the theoretical foundations of that technique in light of theoretical developments over the past hundred plus years. It is argued that free association is similar to an asymptote, which is never quite reached. Moreover, it is argued that the direction to free associate is contraindicated in many, if not most, psychological disturbances. Guided association or avoidance of free association is sometimes required. For a limited group of patients, whose major ego functions (abstraction, integration, and reality testing), ego strengths (impulse control, affect tolerance, and containing primary process), object relations (capacities for empathy, trust, and closeness), and superego (shame/guilt) are intact, the direction to use the couch and attempt to free associate may still be quite useful. For most people who present for treatment, however, this approach is likely not beneficial. The complex arguments about the decision-making process regarding free association are discussed.

(Re)Construction of the body of transgender women: daily search for (in)satisfaction and care?

OBJECTIVE

To analyze the structure and contents of transgender women's social representations of their bodies and body modification practices.

METHODS

Research conducted with 92 women using the Snowball technique. The data were collected using the free evocation of words technique and processed by the Evoc software, which organized the central and peripheral elements.

RESULTS

The representation of the real body includes two structuring aspects: one related to the need to adapt/modify the body conformation according to the self-reported gender, because of the dissatisfaction with the body itself; the second reveals the happiness/satisfaction considering the results obtained through the body modification/adaptation practices adopted in the transition.

FINAL CONSIDERATIONS

The body is constituted as a complex object and was represented by elements that reinforce the understanding of body modifications as needs, with a view to satisfaction, personal fulfillment, and care of one's own body.

Measuring Conceptual Associations via the Development of the Chinese Visual Remote Associates Test

Multiple versions of the Chinese Remote Associates Test (CRAT) have been developed. Thus far, all CRATs have employed verbal stimuli; other forms of stimuli have not yet been used. In this context, the present study compiled a Chinese Visual Remote Associates Test (CVRAT) that conforms to the Chinese language and culture based on a picture naming database. The developed CVRAT has two versions, CVRAT-A and CVRAT-B, each comprising 20 test questions. A typical CVRAT question consists of three stimuli pictures, requiring respondents to propose a target word that is semantically associated with all the pictures. When compiling the CVRAT, this study first selected target words, sifted through stimuli words and corresponding pictures, and analyzed pilot test questions. After compilation, their reliability and validity were examined. The results showed that the CVRAT had moderate internal consistency reliability, good criterion-related validity for the Chinese Word Remote Associates Test (CWRAT), Chinese Radical Remote Associates Test (CRRAT), Chinese Compound Remote Associates Test (CCRAT), insight problem-solving, as well as acceptable discriminant validity for fluency, flexibility, and originality of a divergent thinking test. In other words, CVRAT can effectively measure remote associative capability and provides a figural creativity test that facilitates the understanding of different kinds of remote associations.

Beyond the death drive: Entropy and free energy

In this paper I offer an overview of the possible links between psychoanalytical metapsychology and contemporary work in neuroscience concerning entropy and the free energy principle. After briefly describing the theory of living systems put forward by the neuroscientist Karl Friston based on the notion of entropy, we sum up the use of the notion of free energy by Friston and Freud. I then analyze how these notions improve the intelligibility of psychic functioning and can be associated with several psychoanalytical concepts, in particular the death drive. I approach from the same perspective the regulation of free energy associated with psychic envelopes and early intersubjectivity. It thus appears that the psychic apparatus can be considered at its different levels, from the most primary to the most secondary, as having the essential function of reducing entropy and free energy. Various forms of "failure" of this process of linking, regulation and transformation of energy within the psychic apparatus could be considered as the origin of different psychopathological manifestations as suggested in the last part of this paper.

PSYCHOANALYSIS AS A TWO-PERSON MEDITATION: FREE ASSOCIATION, MEDITATION AND BION

This paper is based on the commonality between free association and the practice of Buddhist meditation in light of the surprising fact that both great traditions devoted to healing human suffering rely on the same fundamental method. After reviewing some aspects of free association and evenly-suspended attention, relevant aspects of Buddhist meditation and Buddhism as a psychology, including thinking and emotion, are compared and contrasted with psychoanalysis. The Buddhist insight of impermanence is highlighted. Freud's telephone metaphor becomes the basis for a discussion of psychoanalysis as a two-person meditation. Bion's proposal for the analyst to eschew memory and desire to be in the moment with his patients serves as an introduction to a case by Thomas Ogden which illustrates both Bion's points and provides an example of a two-person meditation.

Entropy, Free Energy, and Symbolization: Free Association at the Intersection of Psychoanalysis and Neuroscience

Both a method of therapy and an exploration of psychic reality, free association is a fundamental element of psychoanalytical practices that refers to the way a patient is asked to describe what comes spontaneously to mind in the therapeutic setting. This paper examines the role of free association from the point of view of psychoanalysis and neuroscience in order to improve our understanding of therapeutic effects induced by psychoanalytic therapies and psychoanalysis. In this regard, we first propose a global overview of the historical origins of the concept of free association in psychoanalysis and examine how Freud established its principles. Then, from Freud's distinction between primary and secondary processes, we proceed to compare the psychoanalytic model with research originating from cognitive psychology and neuroscience. The notions of entropy and free energy appear particularly relevant at the intersection of these different domains. Finally, we propose the notion of symbolizing transmodality to describe certain specificities of symbolization processes within free association and we summarize the main functions of free association in psychoanalytic practices.

Putative Markers of Repression in Patients Suffering From Mental Disorders

Background: The concept of psychodynamic conflict is essential to psychodynamic theory and therapy. In classical psychodynamic therapy, unconscious conflict themes need to be identified by the therapist and brought to the patient's awareness, in order to work through and ultimately solve them. According to theory, touching upon conflict-related topics leads to arousal, followed by activation of defense mechanisms such as repression. Starting with C.G. Jung's association studies more than 100 years ago, various proposals have been made to investigate psychodynamic conflicts based on free association and psychophysiological measures. This study presents an attempt to identify and differentiate between psychodynamic conflict themes in patients, using an adopted version of Jung's paradigm that had in previous studies been applied to healthy subjects. Method: Seventeen patients suffering from depression and other mental disorders associated freely to different cue sentences. Prior to the experimental procedure, patients' individual psychodynamic conflict types were assessed through clinical interviews. Sentences were either neutral, negative (but not conflict-related), or related to specific types of psychodynamic conflicts. Memory for the first three associations was later tested in an unexpected recall task. Skin conductance response (SCR) was recorded and analyzed together with reaction times (RTs) and self-ratings of emotional valence, arousal, and agreement with cue sentences. Results: Patients showed reduced memory performance for associations to conflict-related sentences in general, compared with negative and neutral sentences. Agreement with conflict-related sentences was lower compared to neutral but not negative sentences. Memory was negatively correlated with RTs and SCR. RTs were longer for conflict types that had been rated as relevant in clinical interviews prior to the association task, compared to the other, non-relevant conflict types. Conclusion: Our study shows that some putative markers of repression of psychodynamic conflicts previously established in healthy participants also occur in patients. Moreover, it provides evidence that general conflict effects differ from specific effects of personally relevant conflicts.

Associative Agreement as a Predictor of Naming Ability in Alzheimer's Disease: A Case for the Semantic Nature of Associative Links

We aimed to address the long-standing issue of the nature of the relationships that link a cue word to words associated with it. In keeping with a recently proposed neuropsychological model of semantic memory (Zannino et al., 2015), we provide support for the hypothesis that associative links are semantic in nature and not lexical. In support of this hypothesis, we demonstrate a relationship in healthy subjects between the probability of producing word X in response to cue word Y in a free association task and the probability of using word X to describe the meaning of word Y. Furthermore, we provide evidence that associative measures are altered in people suffering from Alzheimer's disease (AD) and predict their level of performance in a picture-naming task. We provide a parsimonious account of the experimental data gathered form these different sources of evidence according to the hypothesis that the links between a cue word and its associates can be viewed as binding a concept (the cue) to pieces of information regarding its meaning (the associates).

Processing of a Subliminal Rebus during Sleep: Idiosyncratic Primary versus Secondary Process Associations upon Awakening from REM- versus Non-REM-Sleep

Primary and secondary processes are the foundational axes of the Freudian mental apparatus: one horizontally as a tendency to associate, the primary process, and one vertically as the ability for perspective taking, the secondary process. Primary process mentation is not only supposed to be dominant in the unconscious but also, for example, in dreams. The present study tests the hypothesis that the mental activity during REM-sleep has more characteristics of the primary process, while during non-REM-sleep more secondary process operations take place. Because the solving of a rebus requires the ability to non-contexually condensate the literal reading of single stimuli into a new one, rebus solving is a primary process operation by excellence. In a replication of the dream-rebus study of Shevrin and Fisher (1967), a rebus, which consisted of an image of a comb (German: “Kamm”) and an image of a raft (German: “Floß”), resulting in the German rebus word “kampflos” (Engl.: without a struggle), was flashed subliminally (at 1 ms) to 20 participants before going to sleep. Upon consecutive awakenings participants were asked for a dream report, free associations and an image description. Based on objective association norms, there were significantly more conceptual associations referring to Kamm and Floß indexing secondary process mentation when subjects were awakened from non-REM sleep as compared to REM-awakenings. There were not significantly more rebus associations referring to kampflos indexing primary process mentation when awakened from REM-sleep as compared to non-REM awakenings. However, when the associations were scored on the basis of each subject’s individual norms, there was a rebus effect with more idiosyncratic rebus associations in awakenings after REM than after non-REM-sleep. Our results support the general idea that REM-sleep is characterized by primary process thinking, while non-REM-sleep mentation follows the rules of the secondary process.

Investigating Behavioral and Psychophysiological Reactions to Conflict-Related and Individualized Stimuli as Potential Correlates of Repression

Background: Repression is considered as a central defense mechanism in psychodynamic theory. It refers to the process by which "unbearable" mental contents (e.g., those related to internal conflicts) are kept out of consciousness. The process of repression is probably closely related to concepts of emotion regulation derived from a different theoretical background. This relationship is particularly relevant because it relates repression to current research in the affective neurosciences as well as to experimental studies on emotion regulation. Due to its complex and highly individual nature, repression has been notoriously difficult to investigate. We investigated repression with an individualized experiment in healthy subjects in order to establish methods to study repression in clinical populations. To this end we operationalized repression using individualized experimental conditions, and then studied potential behavioral [memory and reaction time (RT)] and psychophysiological correlates [skin conductance response (SCR)]. Method: Twenty-nine healthy female subjects were asked to freely associate to individualized cue sentences. Sentences were generated from individual psychodynamic interviews based on operationlized psychodynamic diagnosis (OPD), and were comprised of three different types: positive, negative non-conflictual, and negative conflict-related sentences. Subjects were asked to name the first three associations coming into their mind. Afterward, the remaining time was used for free association. SCR during each association trial and RT of the first given association were recorded. The memory for the first three associations was subsequently tested in an unexpected recall. Results: Associations to conflict-related cue sentences were associated with longer RTs and increased SCRs. Moreover, the unexpected recall task showed memory for these associations to be reduced. Conclusion: We interpret these findings as possible correlates of repression, in line with a history of experimental research into repression using non-individualized cues. Consequently, we suggest that this experimental paradigm could serve to investigate repression in clinical populations.

AFFECT, SYMPTOM, FANTASY, DREAM: CLINICAL AND THEORETICAL CONSIDERATIONS

A symptom being studied in the process of analysis can be seen as not unlike the unconscious affect it sprang from. The author presents a case in which a symptom, premature ejaculation, was analogous to the unconscious affect of guilt, which itself seemed to be a premature defensive transformation of a deeper current of anger. Guilt was interpreted as if it were a psychic premature ejaculation, a defensive derailment of anger. Fantasy and dream seemed to be engaged in similar transformations, with a fantasy of "premature incarceration" not unlike the symptom itself in its analogous functioning. Analysis of affect, symptom, fantasy, and dream in complex, integrative analytic process led not only to resolution of the symptom itself, but also to a deeper understanding of the mind's complex functioning in general.

Free Associations Mirroring Self- and World-Related Concepts: Implications for Personal Construct Theory, Psycholinguistics and Philosophical Psychology

People construe reality by using words as basic units of meaningful categorization. The present theory-driven study applied the method of a free association task to explore how people express the concepts of the world and the self in words. The respondents were asked to recall any five words relating with the word world. Afterward they were asked to recall any five words relating with the word self. The method of free association provided the respondents with absolute freedom to choose any words they wanted. Such free recall task is suggested as being a relatively direct approach to the respondents’ self- and world-related conceptual categories, without enormous rational processing. The results provide us, first, with associative ranges for constructs of the world and the self, where some associative dimensions are defined by semantic polarities in the meanings of peripheral categories (e.g., Nature vs. Culture). Second, our analysis showed that some groups of verbal categories that were associated with the words world and self are central, while others are peripheral with respect to the central position. Third, the analysis of category networks revealed that some categories play the role of a transmitter, mediating the pathway between other categories in the network.

Changes in Free Symptom Attributions in Hypochondriasis after Cognitive Therapy and Exposure Therapy

BACKGROUND

Cognitive-behavioural therapy can change dysfunctional symptom attributions in patients with hypochondriasis. Past research has used forced-choice answer formats, such as questionnaires, to assess these misattributions; however, with this approach, idiosyncratic attributions cannot be assessed. Free associations are an important complement to existing approaches that assess symptom attributions.

AIMS

With this study, we contribute to the current literature by using an open-response instrument to investigate changes in freely associated attributions after exposure therapy (ET) and cognitive therapy (CT) compared with a wait list (WL).

METHOD

The current study is a re-examination of a formerly published randomized controlled trial (Weck, Neng, Richtberg, Jakob and Stangier, 2015) that investigated the effectiveness of CT and ET. Seventy-three patients with hypochondriasis were randomly assigned to CT, ET or a WL, and completed a 12-week treatment (or waiting period). Before and after the treatment or waiting period, patients completed an Attribution task in which they had to spontaneously attribute nine common bodily sensations to possible causes in an open-response format.

RESULTS

Compared with the WL, both CT and ET reduced the frequency of somatic attributions regarding severe diseases (CT: Hedges's g = 1.12; ET: Hedges's g = 1.03) and increased the frequency of normalizing attributions (CT: Hedges's g = 1.17; ET: Hedges's g = 1.24). Only CT changed the attributions regarding moderate diseases (Hedges's g = 0.69). Changes in somatic attributions regarding mild diseases and psychological attributions were not observed.

CONCLUSIONS

Both CT and ET are effective for treating freely associated misattributions in patients with hypochondriasis. This study supplements research that used a forced-choice assessment.

PARRHESIA, PHAEDRA, AND THE POLIS: ANTICIPATING PSYCHOANALYTIC FREE ASSOCIATION AS DEMOCRATIC PRACTICE

This essay explores the mostly unexamined analogy of psychoanalytic free association to democratic free speech. The author turns back to a time when free speech was a matter of considerable discussion: the classical period of the Athenian constitution and its experiment with parrhesia. Ordinarily translated into English as "free speech," parrhesia is startlingly relevant to psychoanalysis. The Athenian stage-in particular, Hippolytus (Euripides, 5th century BCE)-illustrates this point. Euripides's tragic tale anticipates Freud's inquiries, exploring the fundamental link between free speech and female embodiment. The author suggests that psychoanalysis should claim its own conception of a polis as a mediated and ethical space between private and public spheres, between body and mind, and between speaking and listening communities.

Neural activity during free association to conflict-related sentences

Psychodynamic conflicts form an important construct to understand the genesis and maintenance of mental disorders. Conflict-related themes should therefore provoke strong reactions on the behavioral, physiological, and neural level. We confronted N = 18 healthy subjects with a vast array of sentences describing typical psychodynamic conflict themes in the fMRI scanner and let them associate spontaneously in reaction. The overt associations were then analyzed according to psychoanalytic theory and the system of operationalized psychodynamic diagnosis and used as a genuinely psychodynamic indicator, whether each potentially conflict-related sentence actually touched a conflict theme of the individual. Behavioral, physiological, and neural reactions were compared between those subjects with an “apparent conflict” and those with “absent conflicts.” The first group reported stronger agreement with the conflict-related sentences, more negative valence in reaction, had higher levels of skin conductance reactivity and exhibited stronger activation in the anterior cingulate cortex, amongst other functions involved in emotion processing and conflict-monitoring. In conjunction, we interpret this activity as a possible correlate of subjects’ inherent reactions and regulatory processes evoked by conflict themes. This study makes a point for the fruitfulness of the neuropsychoanalytic endeavor by using free association, the classical technique most commonly used in psychoanalysis, to investigate aspects of conflict processing in neuroimaging.

Neutrality in the field: alpha-function and the dreaming dyad in psychoanalytic process

Analysts have interpreted the concept of neutrality in a variety of ways, beginning with Strachey's use of that word to translate Freud's (1915) term, Indifferenz. In this paper, neutrality is linked to Freud's notions of free association and evenly suspended attention. A history of psychoanalytic attempts to clarify the concept are presented, with special attention to issues of ambiguity and the patient's role in the determination of neutrality. Neutrality is further elaborated in relation to the bipersonal field as described by the Barangers and contemporary field theorists. Understood in terms of the field, neutrality becomes a transpersonal concept, here conceived in terms of alpha-function and a dreaming dyad. Two clinical examples cast in the light of a Bionian perspective are discussed to suggest an alternative understanding of analytic impasses and their relation to alpha-function and neutrality.

The Associative Structure of Language: Contextual Diversity in Early Word Learning

Previous studies demonstrated that statistical properties of adult generated free associates predict the order of early noun learning. We investigate an explanation for this phenomenon that we call the associative structure of language: early word learning may be driven in part by contextual diversity in the learning environment, with contextual diversity in caregiver speech correlating with the cue-target structure in adult free association norms. To test this, we examined the co-occurrence of words in caregiver speech from the CHILDES database and found that a word's contextual diversity-the number of unique word types a word co-occurs with in caregiver speech-predicted the order of early word learning and was highly correlated with the number of unique associative cues for a given target word in adult free association norms. The associative structure of language was further supported by an analysis of the longitudinal development of early semantic networks (from 16 to 30 months) using contextual co-occurrence. This analysis supported two growth processes: The lure of the associates, in which the earliest learned words have more connections with known words, and preferential acquisition, in which the earliest learned words are the most contextually diverse in the learning environment. We further discuss the impact of word class (nouns, verbs, etc.) on these results.