Guided Enactments In Psychoanalytic Psychotherapy

Thirty five percent of persons who are provided psychotherapy do not benefit from treatment, or drop out of therapy prematurely because they fail to establish a working alliance with the therapist. To address this issue the volume presents a matrix of concepts and research illustrating how traumatic experiences during childhood result in the person developing rigid cognitive functions, emotional expressions and behaviors, interfering with the person participating constructively in relationships. Based on this research, the psychotherapy conducted with an adult, an adolescent, and a child are described to illustrate why and when the therapist should engage and participate with the patient in various body activities to stimulate particular meanings and emotions that promote flexibility in the patient’s cognition, emotions, and behaviors. These cases illustrate how cultivating this flexibility enables the patient to establish a working alliance with the therapist and resolve past traumatic experiences. The volume also describes a therapeutic model of techniques a therapist should follow when adult and adolescent patients fail to establish a working alliance, do not benefit from discussing and free associating, and when child patients do not benefit from play therapy.

The book is dedicated to Jeremy Safran, whose recent tragic loss drove the editor as well as the publisher to gather these contributions about enactment, a topic to whom Safran devoted many papers of his. The collection Borders of Psychoanalysis includes books that investigate an area of research that our publishing house wants to cover since its foundation: that of the dialogue of contemporary psychoanalysis with 'confining' disciplines (for example, neuroscience, infant research, cultural anthropology), often with epistemologies that for origin and history appear to be incomparable to it. As Safran wrote, though problematic and source of confusion among different psychoanalytic approaches, this epistemological status of psychoanalysis, related to its condition of 'liminality', is a meaningful source of vitality for the discipline (Safran, 2012). The book explores the subject of enactment in relation to boundaries in psychoanalysis, referring to a series of viewpoints that lead to many crucial areas. From an intra-psychic point of view, enactment can be studied at the between internal and external (world), psyche and soma, psychic apparatuses (first topic) and 'provinces' (second topic), primary and secondary process, perception and representation, representation and affect, Ego and object, subject and object (included the concept of 'transitional space' by Winnicott). At this level we have to consider that many authors who have take into account very profoundly enactment are those who questioned the linearity of classical Freudian topics (the continuity between unconscious, preconscious and conscious, interrupted only by repression and negation), considering dissociation as a key mechanism apter in order to reflect and account for a discontinuous model of psyche (Bromberg, 2014). From an inter-psychic point of view, enactment can be explored in relation to the concept of intersubjectivity and 'the third' (Aron, 2006; Benjamin, 2004) to indicate the functioning that affects the entire analytic pair at work. At this level we can place all the theories on boundaries of the analytic setting and the whole clinics of their violations. From an intra-disciplinary point of view (inside of psychoanalysis), enactment can be considered according to different currents of contemporary psychoanalytic thought. From an inter-disciplinary point of view, enactment can be viewed as a 'bridge' concept between psychoanalysis and the other 'confining' disciplines, especially psychiatry but also infant research and neuroscience. Moreover, it is to be added an inter-cultural point of view, from which enactment can be considered as a transitional concept allowing to enlight cultural counter-transference phenomena in transcultural clinical setting. Finally, from a trans-generational point of view, studies on the transmission of traumatic conditions across generations (Bohleber, 2007; Faimberg, 2005) can demonstrate that enactments may cross disregard the boundaries between generations that are also places of links and largely unconscious narcissistic pacts (Aulagnier, 1975; Kaës, 2005).

For many therapists it has replaced previous action terms such as acting in and acting out. Something new has been captured by this concept: a recognition of a process that may involve words but goes beyond words. For some, enactment addresses a continuous undercurrent in the interaction between patient and therapist in the realm of intersubjectivity. Others ask whether this concept adds either clarity or a new perspective to the clinical situation. This volume addresses the questions: Does the current focus on enactments entail a shift in our model of therapeutic change? Are enactments essential? Can they be dangerous, and if so, under what circumstances? Enactment is essential reading for all psychotherapists.

TABLE OF CONTENTS: 1. Modes of therapeutic action 2. Intervention as assessment 3. Creating opportunities for self reflection 4. Bringing defenses and unconscious mental content into awareness 5. Interaction structures in the transference countertransference 6. Supportive approaches: The uses and limitations of being helpful 7. Studying psychoanalytic therapy 8. Case studies.

Good supervision is crucial to the training of any therapist. Yet most who are asked to supervise receive little instruction in how best to proceed. What is missing is a theory and technique of supervision that can help them be effective teachers, no matter from what mental health discipline they come. The authors of this book, who have supervised in a variety of educational settings and have taught students from a wide range of mental health disciplines, now provide a theoretical and technical framework for understanding and deepening the supervisory process. They clearly describe phases of supervision (from the opening session to termination), its goals, and the nature and purpose of a number of supervisory interventions. They delineate modes of thinking that are essential to being a good therapist and discuss how best to foster them. They demonstrate how supervision can be intimate, personal, and honest without becoming a form of therapy. Through clinical vignettes, they show how to diagnose impediments to learning and describe strategies for overcoming them. While providing an interesting history of supervision and a portrait of Freud as supervisor, they focus mainly on how newer theories such as self psychology, intersubjectivity, and an interactive two-person psychology influence the practice of supervision.

This book helps the patient of psychotherapeutic intervention to stay with the therapy beyond both the initial satisfactions and the initial frustrations that the process entails. It serves as a guide for patients of psychoanalytic or psychodynamic psychotherapy.

In From Sign to Symbol: Transformational Processes in Psychoanalysis, Psychotherapy, and Psychology, Joseph Newirth describes the evolution of the unconscious from the psychoanalytic concept that reflected Freud’s positivist focus on symptoms and repressed memories to the contemporary structure that uses symbols and metaphors to create meaning within intimate, intersubjective relationships. Newirth integrates psychoanalytic theory with cognitive, developmental, and neuropsychological theories, and he differentiates two broad therapeutic strategies: an asymmetrical strategy that utilizes the logic of consciousness and emphasizes the differentiation of person, place, time, and causality in the world of objects, and a symmetrical strategy that utilizes the logic of the unconscious in the world of emotional, intersubjective experience. He presents multiple approaches to the use of these symmetrical therapeutic strategies, including the use of humor, dreams, metaphors, and implicit procedural learning, in transforming concrete symptoms and signs into the symbolic organizations of meaning. Examples from both psychotherapeutic practice and supervision are presented to illustrate the development of the capacity for symbolic thought or mentalization.