Заключительные наблюдения

Используя себя как зрелого агента в терминах коммуникативной функции, врач не ограничивает себя интервенциями, на которые я обращал основное внимание. Шизофреническому пациенту также требуются те типы коммуникаций, которые обычно используются с другими пациентами. Тем не менее, то, на чем я сфокусировался, является настолько наиболее необходимым, в успешной работе с нарциссически-трансферным сопротивлением, насколько и наиболее трудным чтобы достичь.

Студент-аналитик, читающий эти главы, несомненно найдет их легкими для интеллектуального постижения и предчувствует небольшие трудности в применении их. Однако, в ситуации лицом к лицу с пациентом все оказывается по-другому. Как его собственные чувства, так и чувства пациента будут препятствовать полному осуществлению этих эмоциональных взаимодействий. Всё же они необходимы и должны быть привлечены в нужный момент в терминах трансфер-контртрансферных состояний.

То, что является наиболее характерным для таких интервенций, так это отношения крайности, которые они выражают. На ранних встречах с шизофреническим пациентом ощущается странность, сверхъестественность, отсутствие чего-то, что вызывает тревогу и беспокойство. Когда пытаешься понять его и воспринимаешь его вербальные попытки к контакту как намеки на то, чтобы вмешаться, понимаешь, что слишком много или слишком мало в межперсональных отношениях. по-видимому, паттернизировало шизофреническую реакцию. Есть люди склонные слишком много молчать или же слишком много говорить.

Начальная позиция терапевта такая же как и у студента, изучающего функционирование пациента. То, что изучается, в конце концов должно быть разделено с пациентом. Тем не менее, вначале терапевт представляет себя подобным пациенту для того чтобы облегчить эго-трансфер. Когда он отвечает на контактное функционирование пациента то, чем вводить что-либо "чужеродное" в отношения, ему лучше утилизировать индуцированные чувства настолько, насколько это необходимо чтобы помочь пациенту ангажироваться в прогрессивной коммуникации. Терапевт понимает что он тогда будет вознагражден за успешную работу с сопротивлением, когда он станет мишенью эмоционального взрыва.

Изучение вербальной мимикрии, которая ведет к вентиляции враждебности, раскрывает природу субъективных впечатлений, что мобилизует враждебные реакции, которые пациент не смог разрядить полностью. Мобилизация и разрядка гнева и ярости освобождают пациента для сотрудничества. Когда эти взрывы изучаются вместе с ним, он описывает сновидения, фантазии или воспоминания. Процесс реконструкции его ранних впечатлений первоначальной ситуации и перемещение "чужеродных" объектных впечатлений из эго-поля психики облегчается, таким образом, освобождающей силой интервенций.

Когда терапевт пересматривает интервенции, которые обеспечили наибольшую эффективность в разрешении нарциссически-трансферного сопротивления, он понимает, почему его ответы произвели большее впечатление, когда он представлял себя как ничтожество или диктатора, чем когда он "признавался" обычным человеком. По-видимому, пациент воспринимает свои ранние объекты как крайности, каждая из которых обеспечивает либо слишком богатый пир, либо голод в человеческих отношениях.

СУЩНОСТЬ ВЫЗДОРОВЛЕНИЯ

Когда нарциссически-трансферное сопротивление достигает максимума, пациент кажется увязнувшим в непроизвольном повторении нескольких основных и по-настоящему грубых чувств-тонов раннего детства. Он звучит подобно старой шарманке, играющей установленные мелодии снова и снова. Когда наиболее мощные сопротивления к коммуникации разрешаются, он развивает множество оттенков и утонченностей в чувствовании. В конце концов он становится способным испытывать весь спектр человеческих эмоций. По тому, как он выражает их в аналитических отношениях, можно наблюдать эмоциональную эволюцию человеческого существа. В конечном итоге он достигает богатой "оркестровки" зрелой личности.

Успешно излеченный индивид располагает множеством поведенческих паттернов. Поскольку он может выражать свои чувства социально-приемлемым образом, он не избегает контактов, тем не менее, сохраняется огромная провокация для того, чтобы защитить себя от деструктивного поведения. Он также становится способным воспринимать и переносить эмоции других людей. Эмоциональная восприимчивость и непринужденная отзывчивость меняют всю его ориентацию в жизни. Он может спокойно относиться к людям и готов встретить тяжелые реальности без привлечения старой нарциссической защиты. Пациент больше не представляет очевидности своих старых патологических паттернов, за исключением точного диагностического тестирования или искусного интервьюирования.

Выздоровевший пациент выражает отношения, что он совершил путешествие в самораскрытие. "Я только начинаю понимать кем я являюсь на самом деле," — сказала одна женщина. Большинство пациентов чувствуют что они нашли верного и постоянного компаньона в самом себе, с которым можно общаться на языке чувств. Они испытывают это новое осознавание чувств как важное качество в соприкосновении с жизненными случайностями.

Выздоровление не означает, что исчезнут все трудности, или что новые проблемы не встретятся в будущем. Однако пациент теперь способен справляться с проблемами как цельная личность. Значительно возросли его способности к самореализации и счастью, и он может переносить воздействие травматических событий с большой гибкостью. Он развил выдержку и понимание для того чтобы принимать и разрешать психологические конфликты обычных размеров.

Полностью выздоровевший пациент может воспринимать аналитика как человеческое существо. Он способен понимать и описывать недостатки аналитика, конструктивно критиковать лечебный процесс, и предлагать усовершенствования в подходе аналитика. Если позволить ему поступать подобным образом, пациент может описать факторы, которые привели его к болезни и идентифицировать то, что явилось сущностью для его прогресса.

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SUGGESTED READING

GENERAL PERSPECTIVES (CHAPTER 1)

Auerbach, Alfred (Ed.): Schizophrenia; an Integrated Approach, New York, Ronald Press, 1959.

Bellak, Leo (Ed.): Schizophrenia; A Review of the Syndrome. New York, Logos, 1958.

Boyer, L. Bryce, and Giovacchini, Peter L.: Psychoanalytic Treatment of Characterological and Schizophrenic Disorders. New York, Science House, 1967.

Brody, Eugene B., and Redlich, Frederich C. (Eds.): Psychotherapy with Schizophrenics. New York, International Universities Press, 1952.

Dawson, Joseph G., Stone, Herbert K., and Dellis, Nicholas P. (Eds.): Psychotherapy with Schizophrenics. Baton Rouge, La., Louisiana State University Press, 1961.

Fish, F. J.: Schizophrenia. Baltimore, Md., Williams and Wilkins, 1962.

Hoffer, Abram, and Osmond, Humphrey: How to Live with Schizophrenia. New Hyde Park, N.Y., University Books, 1966.

Jackson, D. D. (Ed.): The Etiology of Schizophrenia. New York, Basic Books, 1960.

Kolb, Lawrence C., Kallman, Franz J., and Polatin, Phillip (Eds.): Schizophrenia. Boston, Little Brown, 1964.

Menninger, Karl: Reversible schizophrenia. Amer. J. Psychiatry. 1:573-688, 1921-1922.

Polatin, Phillip: A Guide to Treatment in Psychiatry. Philadelphia, J. B. Lippincott, 1966.

Rifkin, A. H. (Ed.): Schizophrenia in Psychoanalytic Office Practice. New York, Grune & Stratton, 1957.

Rogers, Carl (Ed.): The Therapeutic Relationship and its Impact; A Study of Psychotherapy with Schizophrenics. Madison, Milwaukee, University of Wisconsin Press, 1967.

Scher, Sam C., and Davis, Howard R. (Eds.): The Out-Patient Treatment of Schizophrenia. New York, Grune & Stratton, 1960.

Usdin, Gene L. (Ed.): Psychoneurosis and Schizophrenia. Philadelphia, J. B. Lippincott, 1966.

CONCEPTUALIZATION OF THE ILLNESS (chapter 2)

Arieti, Silvano: Interpretation of Schizophrenia. New York, Robert

Brunner, 1955.

Bateson, G., Jackson, D. D., Haley, J., and Weakland, J. H.: Toward a theory of schizophrenia. Behav. Sci. 1:251-264, 1956.

Bettelheim, Bruno: The Empty Fortress; Infantile Autism and the Birth of the Self. New York, Free Press, 1967.

Brown, Norman 0.: Life against Death. Vintage, 1959.

Ehrenwald, Jan: Neurosis in the Family and Patterns of Psychosocial Defense. New York, Harper & Row, 1963.

Gibson, Robert W.: The ego defect in schizophrenia. In Usdin, Gene L. (Ed.): Psychoneurosis and Schizophrenia. Philadelphia, J. B. Lippincott, 1966.

Hendrick, Ives: Dream resistance and schizophrenia. J. Amer. Psycho-anal. Ass. 6:672-690, 1958.

Laing, R. D.: The Divided Self. London, Penguin, 1966.

Lilly, John C.: The psychophysiological basis for two kinds of instincts. J. Amer. Psychoanal. Ass. 8:659-670, 1960.

Lipton, Samuel D.: Aggression and symptom-formation. (Discussion) J. Amer. Psychoanal. Ass. 9:685-692, 1961.

Lorenz, 'Konrad: On Aggression. New York, Harcourt, Brace & World, 1966.

Mahler, Margaret S. and La Perriere, Kitty: Mother-child interaction during separation-individuation. Psychoanal. Quart. 34: 483-498, 1965.

Rickman, John: A Survey: The development of the psycho-analytical theory of the psychoses (1894-1926). In. Selected Contributions to Psychoanalysis. New York, Basic Books, 1967.

Scott, John Paul: Aggression. Chicago, University of Chicago Press, 1958.

Silverberg, W. V.: The schizoid maneuver. Psychiatry 10:383-393, 1947.

Sluckin, W.: Imprinting and Early Learning. Chicago, Aldine Publishing Co., 1967.

Spitz, Rene: No and Yes: On the Genesis of Human Communication. New York, International Universities Press, 1967.

The First Year of Life. New York, International Universities Press, 1966.

Stuart, Grace: Narcissus; A Psychological Study of Self-Love. New York, Macmillan Co., 1966.

Winnicott, Donald W.: The Maturational Processes and the Facilitating Environment. New York, International Universities Press, 1966.

AMPLIFICATION OF THE BASIC THEORY (CHAPTER 3)

Arlow, Jacob A., and Brenner, Charles: Psychoanalytic Concepts and the Structural Theory. New York, International Universities Press, 1964.

Ferenezi, Sandor: Thalassa, A Theory of Genitality. Albany, N. Y. Psychoanalytic Quarterly, 1938.

Guntrip, Harry: Personality Structure and Human Interaction. New York, International Universities Press, 1961.

Kanzer, Mark, and Blum, Harold P.: Classical psychoanalysis since 1939. In Wolman, B. B. (Ed.): Psychoanalytic Techniques. New York, Basic Books, 1967.

Lampl-de Groot, Jeanne: On obstacles standing in the way of psychoanalytic therapy. In Psychoanalytic Study of the Child, Vol. 22. New York, International Universities Press, 1967.

Lewin, Bertram D.: The Psychoanalysis of Elation. New York, W. W.

Norton, 1950. Pao, Ping-Nie: The role of hatred in the ego. Psychoanal. Quart. 34: 257-264, 1965.

Rapaport, David: The Structure of Psychoanalytic Theory; A system-atizing attempt. In Psychological Issues, Vol. II, No. 2. New York, International Universities Press, 1960.

Saizman Leon, and Masserman, Jules (Eds.): Modern Concepts of Psychoanalysis. New York, Citadel Press, 1962.

Schumacher, John: "Hate bond" treatment provides delinquent with conscience. Frontiers of Clinical Psychiatry (Roche Report) 5, (No. 5), March 1,1968.

Spitz, Rene A.: A Genetic Field Theory of Ego Formation. New York, International Universities Press, 1959.

Waelder, Robert: Basic Theory of Psychoanalysis. New York, International Universities Press, 1960.

MULTIDISCIPLINARY APPROACH (CHAPTER 4)

Amacher, Peter: Freud's neurological education and its influence on Psychoanalytic theory. In Psychological Issues, Vol. IV, No. 4. New York, International Universities Press, 1965.

Fisher, Charles: Psychoanalytic implications of recent research on

sleep and dreaming. J. Amer. Psychoanal. Ass. 13:197-303, 1965.

Freeman, Lucy: The mind as Freud saw it. In Why People Act that Way. New York, Thomas Crowell, 1965.

Greenfield, Norman S., and Lewis, William C. (Eds.): Psychoanalysis and Current Biological Thought. Madison and Milwaukee, Wisconsin, University of Wisconsin Press, 1965.

Klein, George S.: On hearing one's own voice; an aspect of cognitive control in spoken thought. In Schur, Max (Ed.): Drives, Affects, Behavior, Vol. 2. New York, International Universities Press, 1965.

Lennard, H. and Bernstein, A.: The Anatomy of Psychotherapy: Systems of Communications and Expectation. New York, Columbia University Press, 1960.

Penfield, Wilder and Roberts, Lamar: Speech and Brain-Mechanisms. Princeton, NJ., Princeton University Press, 1959.

Rado, Sandor: Psychoanalysis of Behavior (Collected Papers). Vols. I and II. New York, Grune & Stratton, 1956 and 1962.

—, and Daniels, George E.: Changing Concepts of Psychoanalytic Medicine. New York, Grune & Stratton, 1956.

Rapaport, David: Emotions and Memory (ed. 2). New York, International Universities Press, 1950.

Solomon, Philip, Kubzansky, Philip E., Leiderman, P. Herbert, Mendelson, Jack H., Trumbull, Richard, and Wexler, Donald (Symposium): Sensory Deprivation. Cambridge, Mass., Harvard University Press, 1961.

Whyte, Lancelot: The Unconscious before Freud. New York, Basic Books, 1960.

FROM RUDIMENTARY TO COOPERATIVE RELATIONSHIP (CHAPTER 5)

Brody, Eugene B.: What do schizophrenics learn during psychotherapy and how do they learn it? J. Nerv. Ment. Dis., 127 (No. 1) July, 1958.

Brody, Selwyn: Syndrome of the treatment rejecting patient. Psychoanal. Rev. 51: 243-252, 1964.

Davis, Harold: Short-term psychoanalytic therapy with hospitalized schizophrenics. Psychoanal. Rev. 52:421-488, 1965-1966.

Ekstein, Rudolf, and Wallerstein, Robert S.: The Teaching and Learning of Psychotherapy. New York, Basic Books, 1957.

Knoepfmacher, Lia: Child guidance work based on psychoanalytic concepts. Nerv. Child 5: 178-198, 1946.

Kolodney, Etta: The lessening of casework dependency needs through therapy. Amer. J. Orthopsychiat. 24: 98-110, 1954.

Kubie, Lawrence S.: Practical and Theoretical Aspects of Psycho-analysis. New York, International Universities Press, 1950.

Love, Sidney, and Feldman, Yonata: The disguised cry for help; narcissistic mothers and their children. Psychoanal. Rev. 48 (No. 2) 1-16, 1961.

Family Therapy

Ackerman, Nathan W.: Treating the Troubled Family. New York, Basic Books, 1966.

Boszormenyi-Nagy, Ivan and Framo, James L. (Eds.): Intensive Family Therapy; Theoretical and Practical Aspects. New York, Harper&Row, 1965.

Mishler, Elliott G. and Waxier, Nancy E. (Eds.): Family Processes and Schizophrenia. New York, Science House, 1967.

Group Psychotherapy

Day, Max and Semrad, Elvin: Psychoanalytically oriented group psychotherapy. In Wolman, B. B. (Ed.): Psychoanalytic Techniques. New York, Basic Books, 1967.

Geller, Joseph J., Papanek, Helene, Spotnitz, Hyman, and Wolman, Benjamin B.: Group therapy for schizophrenics. Frontiers of Clinical Psychiatry (Roche Report) 4, (No. 16) Sept 16, 1967.

Ormont, Louis R.: The resolution of resistances by conjoint psycho-analysis. Psychoanal. Rev. 61:426-437, 1964.

Rosenthal, Leslie: A study of resistances in a member of a therapy group. Int. J. Group Psychother. 13:316-327, 1963.

Slavson, S. R.: A Textbook in Analytic Group Psychotherapy. New York, International Universities Press, 1964.

RECOGNITION AND UNDERSTANDING OF RESISTANCE (CHAPTER 6)

Artiss, Kenneth L. (Ed.): The Symptom as Communication in Schizophrenia. New York, Grune & Stratton, 1969.

Bloch, Dorothy: Feelings that kill; the effect of the wish for infanticide in neurotic depression. Psychoanal. Rev. 62:61-66, 1966.

Bychowski, Gustav: Struggle against the introjects. Int. J. Psychoanal. 39:182-187, 1968.

Clevans, Ethel: The fear of a schizophrenic man. Psychoanal. 6 (No. 4):68-67, 1967.

Dahl, Hartvig: Observations on a "natural experiment;" Helen Keller. J. Amer. Psychoanal. Ass. 13:633-660, 1965.

Freud, Anna: The Ego and the Mechanisms of Defense. New York, International Universities Press, 1946.

Glover, Edward: Basic Mental Concepts. London, Imago Publishing Co., 1962.

Jacobson, Edith: The Self and the Object World. New York, International Universities Press, 1964.

Levitan, Harold L.: Depersonalization and the dream. Psychoanal. Quart., 36:167-171, 1967.

Reich, Wilhelm: Character-Analysis. New York, Orgone Institute Press, 1946.

Weiss, Edoardo: The Structure and Dynamics of the Human Mind. New York, Grune & Stratton, 1960.

—: Internalized objects in paranoid schizophrenia and manic-depressive states. Psychoanal. Rev. 60.688-603, 1963-1964.

MANAGEMENT AND MASTERY OF RESISTANCE (CHAPTER 7)

Bibring, Edward: Psychoanalyse and the dynamic psychotherapies, J. Amer. Psychoanal. Ass. 2:746-770, 1954.

Ekstein, Rudolf: Historical notes concerning psychoanalysis and early language development. J. Amer. Psychoanal. Ass. 13:717-731, 1966.

Glover, Edward: The Technique of Psycho-analysis (Chapters IV, V). New York, International Universities Press, 1966.

Greenson, Ralph R.: The problem of working through. In Schur, Max, (Ed.): Drives, Affects, Behavior, Vol 2. New York, International Universities Press, 1966.

Loewenstem, B. K.: Some remarks on the role of speech in psychoanalytic technique. Inter. J. Psychoanal. 37:460-467, 1966.

Nacht, Sascha: Psychoanalysis of Today. New York, Grune & Stratton, 1969.

Novey, Samuel: The principle of "working through" in psychoanalysis. J. Amer. Psychoanal. Ass. 10:668-676, 1962.

TRANSFERENCE (CHAPTER 8)

Berg, Charles: Deep Analysis. London, George Alien & Unwin, 1946.

Bion, W. R.: Language and the schizophrenic. In Klein, M., Heimann, P., and Money-Kyrle, R. (Eds.): New Directions in Psychoanalysis. New York, Basic Books, 1955.

Bychowski, Gustav: Problems of transference. In Psychotherapy of Psychosis. New York, Grune & Stratton, 1952.

Ekstein, Rudolf, and Friedman, Seymour: Object constancy and psychotic reconstruction. Psychoanalytic Study of the Child, vol. 22. New York, International Universities Press, 1967.

Glover, Edward: The Technique of Psycho-analysis (Chapters VII, VIII). New York, International Universities Press, 1955.

Greenacre, Phyllis: The role of transference; practical considerations in relation to psychoanalytic therapy. J. Amer. Psychoanal. Ass. 2: 671-684, 1954.

Orr, Douglas W.: Transference and countertransference; A historical survey. J. Amer. Psychoanal. Ass. 2:621-670, 1954.

Schecter, David E.: Identification and individuation. J. Amer. Psychoanal. Ass. 16:48-80, 1968.

Zetzel, Elizabeth R.: Current concepts of transference. Inter. J. Psychoanal. 37:369-376, 1956.

COUNTERTRANSFERENCE (CHAPTER 9)

Alexander, Franz: Current views on psychotherapy. Psychiatry 16:113-122, 1953.

Burton, Arthur: The quest for the golden mean: a study in schizophrenia. In Burton, A. (Ed.): Psychotherapy of the Psychoses. New York, Basic Books, 1961.

Colby, Kenneth Mark: An Introduction to Psychoanalytic Research. New York, Basic Books, 1960.

Fleiss, R.: Countertransference and counteridentification. J. Amer. Psychoanal. Ass. 1:268-284, 1953.

Fleming, Joan, and Benedek, Therese: Psychoanalytic Supervision. NewYork, Grune & Stratton, 1966.

Fromm-Reichmann, F.: Principles of Intensive Psychotherapy. Chicago, University of Chicago Press, 1950.

—: Psychoanalysis and Psychotherapy (Selected Papers). Chicago, University of Chicago Press, 1959.

Glover, Edward: The Technique of Psycho-analysis (Chapters I, VI). New York, International Universities Press, 1955.

Grinberg, Leon: On a specific aspect of countertransference due to the patient's projective identification. Int. J. Psychoanal. 43:436-440, 1962.

Kernberg, Otto: Borderline personality organization. J. Amer. Psychoanal. Ass. 16:641-666, 1967.

Little, Margaret: "R"—the analyst's total response to his patient's needs. Inter. J. Psychoanal. 38:240-254, 1957.

Meerloo, Joost A. M.: Hidden Communion: Studies in the Communication Theory of Telepathy. New York, Garret Publications, 1964.

Nacht, Sascha: Interference between transference and countertransference. In Schur, Max (Ed.): Drives, Affects, Behavior, Vol. 2. New York, International Universities Press, 1965.

Packer, Heinrich: A contribution to the problem of counter-transference. Int. J. Psychoanal. 34:313-324, 1953.

Savage, C.: Countertransference in the therapy of schizophrenics. Psychiatry, 24:53-60, 1961.

Tauber, Edward S.: The therapeutic use of countertransference. Psychiatry 17:331-336, 1964.

Thompson, Clara: Interpersonal Psychoanalysis (Chapter 18). New York, Basic Books, 1954.

Winnicott, D. W.: Collected Papers, New York, Basic Books, 1958.

Wolstein, Benjamin: Countertransference. New York, Grune & Stratton, 1959.

INTERVENTIONS (CHAPTER 10)

Aull, Gertrude, and Strean, Herbert: The analyst's silence. Psychoanal. Forum, 2 (No. 1):72-87, 1967.

Braatoy, T.: Fundamentals of Psychoanalytic Technique. New York, John Wiley and Sons, 1954.

Eissler, Kurt R.: Notes upon the emotionality of a schizophrenic patient and its relation to problems of technique. Psychoanalytic Study of the Child. Vol. 8, New York, International Universities Press, 1953.

Freud, Anna: Normality and Pathology in Childhood. New York, International Universities Press, 1965, pp. 227-235.

Grossman, David: Ego-Activating Approaches to Psychotherapy. Psychoanal. Rev. 61:401-423, 1964.

Kesten, J.: Learning for spite. Psychoanal. 4 (No. 1): 63-67, 1955.

Livingston, Goodhue: The role of activity in the treatment of schizoid or schizophrenic patients. In Greenwald, Harold (Ed.): New York, Atherton Press, 1967.

Lorand, Sandor: Technique of Psychoanalytic Therapy. New York, International Universities Press, 1946.

Love, S. and Mayer, H.: Going along with defenses in resistive families, i J. Soc. Casework, February, 1955, pp. 130-136.

Nelson, Marie Coleman: Externalization of the toxic introject. Psycho- 1] ' anal. Rev. 43 (No. 2) :236-242, 1956.

—: Role induction: A factor in psychoanalytic therapy. In Paradigmatic Approaches to Psychoanalysis: (Four papers). New York, Stuyvesant Polyclinic, 1962.

Reik, Theodor: Listening with the Third Ear. New York, Farrar Straus, 1948.

—: Surprise and the Psychoanalyst; On the Conjecture and Comprehension of Unconscious Processes. New York, Dutton, 1935.

Saul, Leo J.: Technic and Practice of Psychoanalysis. Philadelphia, Lippincott, 1959.

Scheflen, Albert E.: A Psychotherapy of Schizophrenia; Direct Analysis. Springfield, 111., Charles C Thomas, 1961.

Sherman, M. H.: Siding with the resistance in paradigmatic psychotherapy. Psychoanal. Rev. 48 (No. 4): 43-69, 1961-1962.

Spotnitz, Hyman: The Maturational Interpretation. Psychoanal. Rev. 53: 490-493, 1966.

Stekel, Wilhelm: Technique of Analytical Psychotherapy. New York, Liveright Publishing Corp., 1950.

Sternbach, 0. and Nagelberg, L.: On the patient-therapist relationship in some untreatable cases. Psychoanal. 6 (No. 3): 63-70, 1957.

Strean, Herbert S.: The contribution of paradigmatic psychotherapy to Psychoanalysis. Psychoanal. Rev. 61:365-381, 1964.

—: The use of the patient as consultant. Psychoanal. Rev. 46 (No. 2).-36-44, 1959.

Symonds, Percival S.: Dynamics of Psychotherapy, Vols. I, II, III. New York, Grune & Stratton, 1956, 1957, 1958.

Wolberg, Lewis R.: The Technique of Psychotherapy (Ed. 2). New York, Grune & Stratton, 1967.

NAME INDEX

Abraham, Karl, 16, 38, 208

Ackerman, Nathan W., 217

Adler, Alfred, 19, 160

Adler, Gerhart, 208

Alchhorn, August, 136

Alexander, Franz, 219

Amacher, Peter, 216

Anna 0., 157-159

Arieti, Silvano, 3, 157, 208, 214

Arlow, Jacob A., 215

Artiss, Kenneth L., 218

Auerbach, Alfred, 214

Aull, Gertrude, 220

Bak, Robert, 23, 136, 208

Balint, Alice, 156, 208

Balint, Michael, 133, 144, 156, 208

Bateson,G., 214

Bellak, Leo, 214

Bettleheim, Bruno, 215

Benedek, Therese, 220

Berg, Charles, 219

Bernstein, A., 216

Bibring, Edward, 218

Bmswanger, Ludwig, 38, 39n, 161, 208

Bion, W. R., 219

Bleuler, Eugen, 1, 2, 16,17, 208

Bloch, Dorothy, 218

Blum, Harold P, 216

Boszormenyi-Nagy, Ivan, 217

Boyer, L. Bryce, 135, 208, 214

Braatoy, T., 220

Brenner, Charles, 215

Breuer, Joseph, 149, 157-159, 210

Brill, A. A., IV

Brody, Eugene B, 214, 217

Brody, Selwyn, 217

Brown, Norman 0., 215

Buchsbaum, Monte, 64n

Bullard, Dexter M., 135,172, 208

Burton, Arthur, 219 Bychowski, Gustav, 21n, 208, 218, 219

Cameron, John L, 24, 209

Clark, L Pierce, 136, 208

Clevans, Ethel, 218

Cohn, Franz, 136-137, 208

Colby, Kenneth Mark, 219

Cranefield, P. F, 208

Culpin, M, 3

Dahl, Hartvig, 218

Daniels, George E, 216

da Vinci, Leonardo, 43, 46

Davis, Harold, 217

Davis, Howard R, 214

Dawson, Joseph G, 214

Day, Max, 217

Dellis, Nicholas P., 214

Dement, William C., 78, 208

Dora, 130

Ehrenwald, Jan, 215

Eissler, K. R., 10,182n, 209, 220

Ekstein, Rudolf, 217, 218, 219

Federn, Ernst, 212

Federn, Paul, 23-24, 32, 108n, 132-133, 135, 209

Feldman, Yonata, 211, 213, 217

Fenichel Otto, 18, 93,113, 156, 209

Ferenczi, Sandor, 215

Fish, P. J., 214

Fisher, Charles, 216

Fleiss, R , 220

Fleiss, Wilhelm, 15, 209

Fleming, Joan, 220

Framo, James L., 217

Frankel, Viktor, 182n, 209

Freeman, Lucy, 216

Freeman, Thomas, 24, 138, 209

Freud, Anna, 8 9, 136, 209, 218, 220

Freud, Sigmund, I, 5, 6, 7, 9,10,14, 15, 16, 17, 18, 19-20, 23, 24, 28, 29, 30, 32, 36, 38, 39, 44, 45,51, 52, 53, 54, 94, 95, 98, 107, 110, 111, 114, 117, 118, 130, 131, 132, 133, 149n, 155, 156, 158, 159-161, 179, 180,209-210

Fromm-Reichmann, Frieda, 157, 210, 220

Geller, Joseph J., 218

Gerard, R. W., 51, 210

Gibson, Robert W, 215

Giovacchini, Peter L., 214

Gitelson, Maxwell, 156, 210

Glover, Edward, 25, 210, 218, 219, 220

Greenacre, Phyllis, 219

Greenfield, Norman S., 216

Greenson, Ralph R., 71-72, 99, 112, 113, 210,219

Greenwald, Harold, 209

Grinberg, Leon, 220

Grossman, David, 221

Guntrip, Harry, 215

Haley, J , 214

Hartmann, Heinz, 23, 210

Hendrick, Ives, 23, 33, 135, 210, 215

Hill, Lewis B., 26, 210 Hoffer, Abraham, 214

Jackson, D. D., 214

Jacobson, Edith, 218

Jenkins, Richard L., 25, 210

Jones, Ernest, 159,160, 211

Jung, C. G., 16,17,156,160, 211

Kallman, Franz J., 214

Kanzer, Mark, 216

Kardiner, Abram, 25, 211

Katan, Maurits, 18, 211

Kernberg, Otto, 220

Kesten, J., 221

Klem, George S., 216

Klein, Melanie, 21-22, 33,134, 211

Knoepfmacher, Lia, 217

Kolb, Lawrence C., 214

Kolodney, Etta, 217

Kraepelin, Emil, 2

Kubansky, Philip E., 217

Kubie, Lawrence, 217

Lagache, Daniel, 134, 211

Laing, R. D., 215

Lampl-de Groot, Jeanne, 216

LaPerriere, Kitty, 215

Leiderman, P. Herbert, 217

Lennard, H,216

Levitan, Harold L., 218

Lewin, Bertram D., 216

Lewis, William C., 216

Lilly, John C., 215

Lipton, Samuel D., 215

Little, Margaret, 139, 164, 211, 220

Livingston, Goodhue, 221

Loewenstein, R. M., 219

Lorand, Sandor, 221

Lorenz, Konrad, 215

Love, Sidney,217,221

Mahler, Margaret S., 215

Masserman, Jules, 216

Mayor, H.,221

McGhie, Andrew, 24, 209

Meerloo, Joost A. M., 134, 211, 220

Mendelson, Jack H., 217 Menninger, Karl, 3, 10, 94,113, 211, 214

Michelangelo (statue of Moses), 160

Mishler, Elliott G , 217

Morel, Benedict A., 2

Nacht, Sascha, 219, 220

Nagelberg, Leo, 211, 213, 221

Nelson, Marie Coleman, 134,194n, 211, 221

Novey, Samuel, 219

Nunberg, H.,20-21,33,135,211

Ormont, Louis, 218

Orr, Douglas W, 219

Osmond, Humphrey, 214

Pao, Pmg-Nie, 216

Papanek, Helene, 218

Penfield, Wilder, 216

Polatin, Phillip, 212, 214

Racker, Hemrich, 168, 212, 220

Rado, Sandor, 216

Rapaport, DaVid, 216, 217

Redlich, Frederick C., 214

Retch,, Annie, 156, 212

Reich, W., 133, 218

Reik, Theodor, 21, 221

Resnikoff, P., 213

Rickman, John, 216

Rifkin, A. H., 214

Roberts, Lamar, 216

Rogers, Carl, 214

Rolland, Romain, 107

Rosen, John N., 27, 212

Rosenfeld, Herbert, 21, 137, 167, 212

Rosenthal, Leslie, 218

Salzman, Leon, 216

Saul, Leon J., 212, 221

Savage, C., 220

Schecter, David E., 219

Scheflen, Albert E., 221

Scher, Sam C., 214

Schlesinger, Benno, 27, 212

Schumacher, John, 216

Scott, John Paul, 216

Searles, Harold, 138-139, 140, 167, 212

Sechehaye, Marguerite, 26-26, 33, 212

Semrad, Elvin, 217

Sherman, M. H., 221

Silverberg, W. V., 216

Silverman, Julian, 64n

Slavson, S R., 218

Sluckin, W., 216

Solomon, Philip, 217

Spitz, Rene, 216, 216

Spotnitz, Hyman, 211, 212-213, 218, 221

Stekel, Wilhelm, 221

Stern, Max, 136, 213

Sternbach, 0., 221

Stone, Herbert K., 214

Stone, Leo,136,137,213

Strean, Herbert, 220, 221

Stuart, Grace, 216

Symonds, Percival S., 221

Tauber, Edward S., 220

Thompson, Clara, 220

Trumbull, Richards S., 217

Usdin, Gene L., 214

Waelder, Robert, 136, 213, 216

Wallerstein, Robert, 138, 213, 217

Waxler, Nancy E., 217

Weakland, J. H., 214

Weiss, Edoardo, 108n, 213, 218

Wenar, Solveig, 212

Wexler, Donald, 217

Whyte, Lancelot, 217

Winnicott, Doland, 163, 213, 216, 220

Wolberg, Lewis H., 221

Wolman, Benjamin B., 218

Wolstein, Benjamin, 220

Zeigarnik, B., 134

Zetzel, Elizabeth R., 219

Zilboorg, Gregory, 22, 213

SUBJECT INDEX

Acting out. See Treatment-destructive resistance

Activity of analyst, 63, 66-67, 110-111, 180

See also Interventions Affect(s) 26, 129, 143, 163,161

See also Narcissistic transference, Transference, and specific entries

Aggression (aggressive drive, cathexes, impulses), 26, 33-36, 66, 66, 106, 108, 136, 140, 142, 146, 161, 166, 160, 183, 192

against the self, 21-23, 28, 190, 201

in clinical situation, 30-32

defense against, 20-21

early views on, 18-23

mobilized at trauma level, 19, 28-31

potential for, 35

role in schizophrenia, 19, 28

See also sub Schizophrenia, nuclear problem in, and Working hypothesis

Ambulatory treatment, 4, 5n, 12, 66,83

requirements for, 70-71, 77 American Psychiatric Association, 3

"Analysis Terminable and Interminable," 131

Anger, 26,146,191,196,206

Anxiety, 18, 23, 66, 64, 83, 84, 120-121, 134, 141,143,146

Autobiographical Study, An, 131

"Baby sitting," 82,173-176

Body-ego, 17

Beyond the Pleasure Principle, 131

Causal therapy,6,36

Character problems, 47, 176

Communications of analyst, 69, 197, 206

to family, 90-91

in initial interview, 73-76

maturational, 63, 64, 181-183

multidisciplinary approach to, 43-68

nonverbal, 67, 176-176,178

quantification of, 60-68

See also Interventions

Communications of patient, 5, 102-103, 107, 109,124,142

nonverbal, 103,176-176,186

progressive, 62-63, 124, 196, 198, 202

repetitive, 62-63

symbolic, 103, 109, 142, 186, 186, 188, 190, 192, 194, 196, 196, 198, 199, 201, 202-204, 206

See also Resistance, Transference resistance. Treatment-destructive resistance Constructs, 149, 160, 166-166

See also Reconstruction

Contact functioning, 42, 66, 103-104, 112, 144, 160, 167, 204

See also Interventions Contract. See sub Treatment relationship

Cooperative functioning, concept of.

See sub Treatment relationship

Couch, 78, 78n, 89, 101, 121, 170, 183, 189, 196-197, 198

Counter-resistance, 162

See also Countertransference resistance, Induced feelings Countertransference, 9, 165-166, 162-166

analysis of, 167,163,166,167/176

and transference, 167,161,164

and reconstruction, 166-166

and specific transference states, 168-170

as resistance, 9, 41-42, 167

as therapeutic leverage, 9, 41-42, 166, 167, 172

definition of (scope), 162-163

distinguished from analyst's transference,162

in Case of Anna 0., 157-159

in schizophrenia, 156-157

narcissistic countertransference, 167, 168-170

negative countertransference, 41, 151-155

objective countertransference, 163, 164,166-167,168-170,190

prototype of, 158

subjective countertransference,163-164, 166,174

suppression or repression of, 37, 162, 166, 161, 166-167

use of, in treatment, 9, 167, 163, 165-166,175

See also Countertransference resistance, Induced feelings

Countertransference resistance, 38, 41,42,166,162,170-175

clues to, 170-171

sources of 164, 172-176

Cure, concept of, 1-2

patient's theory of, 186-187

See also Personality maturation

Decisions, major, during treatment, 89,96

De-egotization of the object, 141, 146-147, 176,186

See also Ego field and object field, Egotization of the object Defense(s), 26, 26, 28, 32-34, 49, 66, 107, 108-109, 111, 114, 116, 127, 134, 169,183

activated by transference, 62

earliest modes of, 22

emotional neutrality as, 164

failure of, 30

in latent cases, 30-31

mechanisms in psychotic conditions, 14, 21-22, 23, 28

mobilization of, 183

narcissistic, 42, 102, 111, 113, 206

See also Resistance primary, 118

schizophrenia as, 28

Defense psychosis, 14

Demands, special, on analyst.

See sub Treatment relationship

Demence precoce, 2

Dementia praecox, 2, 3, 17, 131-132

See also Schizophrenia

Dependency cravings, 86, 98,122

Depression, 16,132,143

Diagnosis.

See sub Schizophrenia

Diagnostic Manual, 3, 4, 4n

Dreams, 66, 101. 107, 117

Dream state (and rudimentary relationship), 78-79

Dream studies (contemporary), 62

Drives, instinctual. See Instinctual drives

Drugs, use of 12, 83

Dynamics of personality development, 46-51

neuropsychological formulation on, 51-60

Early maternal environment, 27

Ego and the Id, The, 19

Ego boundaries, 24, 31, 40, 102, 106,107,108

Ego deficiencies in schizophrenia, 86, 94, 112, 116, 121

Ego feeling, 24 Ego field and object field, 28, 40, 106-109, 141, 147, 160, 206

first object field, 106-107

in narcissistic transference, 108

revival of previous fields, 107

See also Egotization of the object, Objectification of the ego

Ego formation and frustration, 23-27

early stage of, 106-107

See also Ego boundaries, Ego field and object field, Identification

Ego passage, 108n

Ego sacrifice, 26, 28, 31-32, 33, 34, 36

Ego-syntonic object. See sub Transference object

Egotization of the object (introjection), 108-109, 139-140, 176

See also De-egotization of the object, Ego boundaries. Ego field and object field Emotional communication, 41,161

See also sub Interventions

Emotional maturity, 48, 154

See also Personality maturation

Environmental manipulation, 4, 90

See also Resistance, external

Errors, 161, 177

theoretical. See sub Psychoanalysis (method)

Etiology. See sub Schizophrenia "Experience of satisfaction," 29

Extremist attitudes, 205

Failure in treatment, 11, 16, 66, 96, 98, 109,190

Family, contact with. See sub Treatment relationship

Family history, taking of, 74-76

Fantasies, 101-102, 106, 137, 138, 143, 146, 148,190,194

Fees and financial transactions. See sub Treatment relationship

Fields of awareness. See Ego field and object field

First International Psychoanalytic Congress, 16-16

Free association, 78, 98, 113, 114, 116, 183

neural significance of, 69

reformulation of fundamental rule, 183

See also Communications of patient, Verbalization, focus on

Frustration, 24-27, 31, 33

See also Frustration-aggression

Frustration-aggression, 22-26, 28-36, 48-49, 61, 66, 140, 163

facilitating release of, 116

interference with ego and superego functioning, 115 and resistance, 102, 104, 107, 116

See also Aggression, Verbalization, focus on

Functional disorders, spectrum of, 47

Goals of treatment, 8, 96

initial, of patient, 69, 73-74, 81

Group for the Advancement of Psychotherapy, 157

Group psychotherapy, 90

Guilt, 81, 91, 106, 109, 116, 136, 144, 147, 196

Hate countertransference, 41

See also Countertransference, negative

Hate, hatred, 19-23, 26, 30, 33-34, 39, 99-100, 134-136, 137, 138, 147, 163, 168-169, 160-161, 163, 172, 191, 196, 202-204

and erotic tendencies, 19

and indifference, 132

in personality development, 168-169

as therapeutic force, 39

verbalization of self-hatred, 192-193

See also Aggression, Transference, negative

Hostility, 16, 22, 26, 40-41, 108, 137, 142, 163, 160-161

graduated release of, 196

Hypocritical stage (patient at), 199

Homosexual feelings, 20, 132, 148

Hysteria, 6,14,16,17, 168

See also Psychoneurosis

Identification (s) 20, 107, 135, 136, 147, 205

analyst's concordant and complementary, 168

and character problems, 176

and transient improvements, 176

with analyst, 164, 174, 176, 196

See also Egotization of the object

Immature personality, 49

Immunization, 11, 125, 200

See also Toxoid response

Impulses, aggressive.

See Aggression Impulse disorders, 47

Indifference, 132

Indirect method, 43-46

Induced feelings, 9, 41, 86,125,141, 162, 159-160, 161, 163-164, 165,167-170,172,176-177,200, 201, 205

See also Countertransference, objective

Initial interview, 70, 73-76,100

Insight, 8,113-114

Instinctual drives (impulses), 18,

20, 30, 33-34

aggressive, 18-19, 33-35.

See also Aggression aim of, 20

erotic, 33

oedipal and genital strivings, 151

See also Libidinal factors

Insulation against unwanted feeling states, 34, 111

See also Aggression, Libidinal factors

Interpretation (s), 6-8, 22, 37-38, 41-42, 110, 112, 113-114, 123, 124, 126-127, 149, 180, 197

of content, 181

of dreams, 117

maturational, 182, 194-195,199

of oedipal problems, 126

of preverbal resistance, 196

on request, 182

sequence in, 195

of transference resistance, 127, 195

See also Interventions

Interpretation of Dreams, The, 28-29, 95

Interruptions in treatment, 88, 124

Interventions, 8, 60, 61-68, 115, 116, 126,178-207

changing character of, 181

commands (orders), 181, 183-184, 186

directions, 183, 196

emotional communications, 125, 126, 127, 182, 190-194, 204-205

emotional confrontations, 182, 190, 191

explanations, 75, 96, 112, 115, 120, 181, 187-188, 197, 199, 200

general principles for, 179-183

interpretations. See Interpretations

joining. See Joining techniques maturational communications, 62, 64,181-182

maturational interpretations. See Interpretations mirroring, 182.

See also Joining techniques

need for repetition in, 180,182

parsimony in, 60, 179,180

questions. See Questions range of, 64-68, 181

reflective, 112, 148,182

See also Joining techniques sequence in,181,196-204

verbal descriptions, 126

verbal feedings on self-demand schedule, 104, 116, 181, 196

See also Communications of analyst, Contact functioning,

Interventions, illustrations of Interventions, illustrations of accepting distorted impressions

of analyst, 197, 199

analyst's shortcomings, 187

auxiliary ego, 194

commands (orders), 183-184

devaluating the object, 190-191

echoing the ego, 190

ego-maniacal approach, 186, 190

ego-oriented questions, 186-187

explanations, 187

factual questions, 184-185

falling apart, 188-189

grilling for evidence, 184-185

hypocritical stage, 199

influencing one resistance pattern, 201-204

maturational interpretations, 195-196

meeting threats with threats, 189

modeling new behavior, 194

object-oriented questions, 185-186

"outcrazying" the patient, 192

patient's expectations, 186—187

saturating with suggestions, 189

suicide or patienticide, 192-193

toxoid response, 200-201

warm acquiescence, 193

weather, 188

Introjection, 106,108,147, 185

See also Egotization of the object

 

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