Extensions of Psychoanalytic Technique: The Mutual Influences of Standard Psychoanalysis and Transference-Focused Psychotherapy

The author describes the differences between standard psychoanalysis and transference-focused psychotherapy (TFP) and reviews particular difficulties that psychodynamically trained clinicians have in learning TFP. In delineating differences between standard psychoanalysis and TFP, the author discusses mutual influences between standard psychoanalytic techniques and techniques of TFP. TFP is an extension and modification of standard psychoanalysis, but with quantitative modifications geared to the treatment of the most severe segment of personality disorders that tend not to be treatable by standard analysis. TFP includes some features that are directly facilitated by psychoanalytic education, such as the importance of free association and the organization of interpretations in terms of the analysis of defense, motivation, and impulse. On the other hand, TFP provides new strategies, enhancing standard psychoanalytic treatment, when it modifies technical neutrality under certain circumstances, allows for the analysis of “incompatible realities,” and accelerates interventions under conditions of severe acting out when technical neutrality is not possible to maintain. The author demonstrates the advantages of systematic training in TFP within psychoanalytic institutes as a true enrichment of technical training. He proposes that psychoanalysis as a profession consists of a broad spectrum of treatment approaches based upon the combined utilization of psychoanalytic techniques, with specific modifications to be organized in specific forms of psychoanalytic psychotherapy. TFP may be the closest modification to standard psychoanalysis proper and is clearly defined and manualized. This has permitted empirical research that has already demonstrated the effectiveness of TFP.

Clinical Applications of Neuropsychoanalysis: Hypotheses Toward an Integrative Model

Neuropsychoanalysis has been established as a field based on the dialog between psychoanalysis and the neurosciences. Freud was a neurologist for 20 years and used the neuroscientific knowledge of his time as the foundation of his metapsychology. Psychoanalysis has predominantly relied on its own method to develop techniques for the different psychoanalytic treatments. It rarely uses contributions from fields outside psychoanalysis that could enrich its understanding of the mind. Neuropsychoanalysis has informed and revised several topics in psychoanalysis, for example consciousness and the unconscious, dreams, and affect amongst many others. Clear clinical applications of neuropsychoanalysis can be appreciated in the work with neurological patients. However, a constant question from clinicians is whether neuropsychoanalytic findings can contribute to psychoanalytic treatments with non-neurological patients. This paper explores clinical applications of neuropsychoanalysis mainly based on affective neuroscience to propose an analysis of emotions that may contribute to the gradual development of a neuropsychoanalytically informed psychotherapy. The task of integrating neuroscientific knowledge into psychoanalytic technique is still considered a challenge of accentuated complexity, but it is at the same time a necessary and promising endeavor that aims at improving the quality of the treatments available for human suffering and psychopathology.

The Unthinkable: Representation and the Encounter With Trauma

The author explores the notion of representation and trauma, taking into account their negative manifestation in the mind, as memories without representation. In the face of massive trauma, the mind deploys dissociative mechanisms, so the experience remains unrepresented. Psychoanalytic technique has to expand its scope in order to meet-create these unrepresented forms. Alongside our classic technique, the analyst needs to work in a particular way—one that involves a regressive state to preverbal, or even prerepresentational areas within the analyst, allowing him or her to gain access to the traumatic zones. The integration of the trauma into the systems of representations depends on the possibility of the analyst to submit to a process of regression so as to offer a substrate on which hitherto unformed experience may assume form and become represented.

Developing Homosexuality: Fritz Morgenthaler, Junction Points and Psychoanalytic Theory

The Swiss psychoanalyst Fritz Morgenthaler (1919–84) is well known in German-speaking psychoanalysis as an early exponent of Heinz Kohut's self psychology, as an ethnopsychoanalytic researcher and as an original thinker on the topics of dreams, psychoanalytic technique and especially on sexuality (perversions, heterosexuality, homosexuality). In 1980, he presented the first psychoanalytic conception of homosexuality in the German-speaking world that did not view homosexuality in terms of deviance or pathology. His theory of ‘junction points’ ( Weichenstellungen) postulates three decisive moments in the development of homosexuality: a prioritized cathexis of autoeroticism in narcissistic development, a Janus-facedness of homosexual desire as an outcome of the Oedipal complex and the coming out in puberty. According to Morgenthaler, this development can result in non-neurotic or neurotic homosexuality. Less known than the theory of junction points and to some degree even concealed by himself (his earlier texts appeared later on in corrected versions) are Morgenthaler's pre-1980 accounts of homosexuality which deserve to be called homophobic. Starting with a discussion of this early work, the article outlines Morgenthaler's theoretical development with special focus on his theory of junction points and how this theory was taken up in psychoanalytic theory.