The Affective Origin and Treatment of Recurrent Maladaptive Patterns

Recurrent maladaptive patterns (RMPs) have been a foundational concept in psychodynamic therapy (PDT) and psychoanalysis for over a century. Typically associated with character pathology (i.e., personality disorders), they highlight the remarkable correspondences frequently observed between relationship patterns in a person’s family of origin, their current adult relationships, and the transference relationship with the therapist. These patterns can be understood as an expression of schemas and therefore share a common conceptual foundation with other major psychotherapy modalities. Yet, the centrality of affect in the origin/development of these maladaptive patterns and their treatment may not be widely appreciated among practitioners of PDT or any other modality. The basic thesis of this chapter is that RMPs as described in the PDT literature could potentially become more widely recognized, understood, and treated in an integrated manner if their developmental and affective origin were more generally appreciated. Doing so would not only improve interpersonal functioning but could also alter the affective dysfunction that predisposes to the development of symptoms that are a common reason for seeking treatment. Consistent with newer developments in psychodynamic theory grounded in observations from early childhood development, this chapter briefly reconsiders the fundamental elements of RMPs, including unconscious processes, development, conflict, defenses, and mechanisms of change from the perspective of affective science and computational neuroscience. In so doing, the goals are to broaden appreciation of the importance and ubiquity of RMPs by explaining them in nonclinical language, to increase the likelihood of enduring change by promoting an integrative approach to their treatment focusing on new emotional experiences in meaningful contexts and to facilitate research that can potentially establish the benefits of such an approach.

Transference interpretations as predictors of increased insight and affect expression in a single case of long-term psychoanalysis

Improved insight and affect expression have been associated with specific effects of transference work in psychodynamic psychotherapy. However, the micro-associations between these variables as they occur within the sessions have not been studied. The present study investigated whether the analyst’s transference interpretations predicted changes in a patient’s insight and emotion expression in her language during the course of a long-term psychoanalysis. 449 thematic units from 30 sessions coming from different years of psychoanalysis were coded by outside raters for analyst’s use of transference interpretations using Transference Work Scale, and patient’s insight, positive emotions, anger and sadness were calculated using the Linguistic Inquiry and Word Count System. Multilevel modeling analyses indicated that transference interpretations positively predicted patient’s insight and positive emotion words and negatively predicted anger and sadness. The qualitative micro-analyses of selected sessions showed that the opportunity to explore negative emotions within the transference relationship reduced the patient’s avoidance of such feelings, generated insight into negative relational patterns, and helped form more balanced representations of self and others that allowed for positive feelings. The findings were discussed for clinical implications and future research directions.

Pliable Media as Transitional Space: From Psychotic Indifferentiation Toward The Construction of Meaning in Schizophrenia

Clinical material from the treatment of a highly destructive schizophrenic patient is used to demonstrate the role and function of therapeutic mediations in promoting transformation and symbolization. Use of the Squiggle Game as a therapeutic mediation is shown to sustain the therapeutic process and to facilitate working through of the obscure and complex dynamics commonly seen in the treatment of psychotic patients. The Squiggle Game presents a first transitional space entailing both the concreteness of psychosis and the potential for symbolization provided by psychoanalysis. The game becomes the first meeting ground for the progressive encounters of the therapeutic couple, primarily because in it the violent destructiveness of psychosis is partly deflected in a way that fosters development of the transference relationship. Step-by-step emotional transformations gained through the Squiggle Game are reported and discussed, together with the patient’s need to rely on nonverbal communicative modes to bring early traumatic experiences that never reached verbalization into treatment. This working through process furthered development of the dyad’s intense transference-countertransference dynamics, which stimulated construction of a link between here-and-now and there-and-then in sessions, leading to the patient’s integration and a sense of the life-historical significance of her experience.

Memoria: reflexiones sobre el tiempo en psicoanálisis. / Memory: reflections on time in psychoanalysis.

El tema abordado es la memoria como eje conceptual de los movimientos subjetivos transitados en la sesión analítica. Se revisan las primeras definiciones de la cura entendida como recuperación mnémica y las definiciones posteriores en la obra de Freud en las que la repetición es la forma que adquiere el recuerdo en la transferencia. Se resitúan estos planteamientos con los descubrimientos de la neurociencia en los que las nociones de memoria procedural y memoria implícita, permiten hipotetizar desde otra perspectiva las formas en que el psicoanálisis sería herramienta de recuperación histórica. Se problematiza la noción de temporalidad con la que se hace necesaria pensar la situación analítica. The subject of this paper is the memory, as a conceptual guideline to the subjective movements that take place in psychoanalytic therapy. Several perspectives are examined, from analytic cure as mnemonic recovery, to subsequent definitions in Freud’s work, in which repetition is conceived as the materialization of memory in the transference relationship. These approaches are put in place in the context of neuroscience’s discoveries; the notions of procedural memory and implicit memory suggest a different perspective regarding psychoanalysis as a tool of historic recovery. The notion of temporality in the analytic situation is discussed.

Transference: keeping mum or mummified?

SummaryTransference reveals the mental state of the other to us through our countertransference. Our emotional responses to the transference relationship are different depending on the degree of disturbance evoked in us. Reflecting on our countertransference can convey emotional insight into the nature and meaning of the transference as a way of understanding the emotional experiences of the other.

Medea, Jason, and their illusions of the Golden Fleece: a Jungian contribution to transference dreaming

Intense projections of love and power regularly occur in the transference relationship. They often objectify archetypal aspects that a client might be struggling to understand. The tale of the Golden Fleece, which stands as a symbol for an inappropriately overvalued attachment, reveals that Jason and Medea were too captivated by their own desires, which they projected onto the Golden Fleece. They failed to appreciate the unattainable – and sacred – nature of the object. The author uses this myth to draw a parallel with certain dynamics of the transference relationship, when the therapist becomes the obscure object of the client's desire or envy. Transference dreaming opens the door to a critical examination of this relationship. The dreamer frequently sees something in the dream that does not add up. This internal uncertainty within the dream indicates that the therapist needs to examine what is happening in the transference or countertransference that heretofore has been accepted uncritically. Three key questions about the analytic relationship are addressed as aspects of what merits further attention in order to be understood and processed collaboratively to make therapeutic space for doubt and illusion.