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