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.

Elton Mayo and Thomas Henry Reeve Mathewson: the forgotten Australian pioneers of the treatment of patients with shell shock, neurasthenia and nervous breakdown

The contributions of Australians on shell shock are absent from the literature. However, two Australians were pioneers in the treatment of shell shock: George Elton Mayo (1880–1949) and Dr Thomas Henry Reeve Mathewson (1881–1975). They used psychoanalytic approaches to treat psychiatric patients and introduced the psychoanalytic treatment of people who suffered from shell shock. Their ‘talking cure’ was highly successful and challenged the view that shell shock only occurred in men who were malingering and/or lacking in fortitude. Their work demonstrated that people experiencing mental illness could be treated in the community at a time when they were routinely treated as inpatients. It also exemplified the substantial benefits of combining science with clinical knowledge and skill in psychology and psychiatry.

Analyzing from Home: The Virtual Space as a Flexible Container

This manuscript explores the experience of teleanalysis for analyst and patient during the COVID-19 pandemic through the lenses of embodied intersubjective relating, the neurobiology of social engagement, and technologically mediated human interaction. At the beginning of the pandemic, many analytic dyads were embarking on remote work for the first time. More than a year later, we are facing the question of whether we will ever return to in-person work. In order to unpack this question, it is useful to consider how in-person analysis and in-person interaction more generally differ from remote interaction. Multiple nonverbal modalities are responsible for affective coregulation in intersubjective relating, including voice, body, and shared physical space. While conscious awareness tends to concentrate on auditory and visual inputs, other sensory inputs also impact affective experience. The impact of physical distance upon psychoanalytic treatment is compared with that of the couch. The shift in the balance of power introduced by teleanalysis is considered. Analyzing and being analyzed from home bend the frame of psychoanalysis, complicating notions about distance and intimacy and opening new spaces in which meaning can be cocreated. The COVID-19 pandemic presents an opportunity for psychoanalysis to engage more deeply with the questions raised by teleanalysis in order to enhance our understanding of its impact on treatment.

The Origins of the Leading Edge in Kohut's Work

This article traces the evolution of the concept of the leading edge in Kohut's work. The leading edge is defined as the growth-promoting dimension of the transference. The authors argue that although Kohut did not ever use the term explicitly in his writings—Marian Tolpin (2002), one of Kohut's gifted pupils, introduced the concept into the psychoanalytic literature in the form of the forward edge—the idea of the leading edge was already present in nascent form in Kohut's earliest papers and became ever more central as his psychology of the self evolved and the concept of the selfobject transference took center stage. Kohut, it is argued, could not fully develop the idea of working with the leading edge for fear of being accused of advocating for a corrective emotional experience in psychoanalytic treatment. However, in his posthumous empathy paper (1982) Kohut came as close as he could to endorsing the leading edge as pivotal in all psychoanalytic work.

From the Imaginary to Theory of the Gaze in Lacan

To understand Lacan’s thinking process on vision, the entirety of his teaching must be taken into consideration. Until the 60s, the visual field is the imaginary, the constitutive principle of reality in its phenomenal giving to the experience of a subject. This register is the opposite of the field of the word with the L schema and, subsequently, as subordinated to the symbolic system according to the model of the optical schema of the inverted flower vase of Bouasse. It is only with the 1964 seminar that Lacan makes a daring turnaround through which the visual becomes a sign of the emergence of a real that is irreducible to both reality and the mediation of the subject of knowledge. The split that separates reality and the real is reproduced in Lacan within the visual field, which is, on the one hand, the cardinal principle of the consistency of the experience of reality (as imaginary), and on the other, it is an element of irreducibility to reality (as object gaze). This produces a cascade of consequences: first of all, the modification of the presentation of the mirror stage. Unlike the voice, which through prosody, tone, and volume, finds some strips with which anchor itself imaginatively to reality, the gaze, invisible and elusive, escapes the imaginary grasp. Captured in myths, it reveals its power and ability to annihilate—as in the myth of Medusa’s gaze—or to make people fall in love but only with a narcissistic love that leads inexorably to death as in the myth of Narcissus. The gaze is elusive because the subject is dependent on it in the field of desire. Like the voice, it is about the desire on which the subject is supported; it is one of the objects on which the phantom depends. In our opinion, thanks to this characteristic, the gaze object can make remote psychoanalytic treatment possible through easily accessible videoconferencing tools and, at the same time, create new conditions within it that should be carefully evaluated to understand its implications in the session itself.