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Journal: Journal of the American Psychoanalytic Association


How we listen to the potential space of online relations is rapidly becoming part of our daily work. Two treatments are examined where themes of sexual shame, repression, and relational difficulties were found and refound through online relating and hooking-up. Consideration is given to the ways in which online exploration opens a potential space that affords sexual practice and the reach of relationality. Moving with these patients into this potential space opened onto an intriguing and productive relational field. These cases help illuminate a shift in our modern social order, and how that shift has followed on a reconsideration of our psychoanalytic ideals about sexual well-being. We are now positioned to reflect not only on the evolution and revolution of our shifting sexual cultures, including the increasing role of technology in our modern relational world, but on how this new world finds its way into our consulting rooms.

Concepts: Sociology, Force, Ciara, Shame, Like a Boy


Suffering is commonly seen as an unconscious effort to alleviate painful feelings of guilt. However, suffering also aims at averting loss of ego functions and hence loss of mental stability. This second function of suffering is discussed in the light of Freud’s observations of characters wrecked by success and Weiss’s ideas about mutual love as a threat to mental stability. Hawthorne’s portrayal of Arthur Dimmesdale in The Scarlet Letter (1850), biographical material about the author, material from his diaries, and material from a psychotherapy case and an analysis illustrate the function of suffering to preserve mental stability in the face of heightened success and happiness. Hawthorne, it is argued, intuitively grasped this function of suffering in his novel.

Concepts: Psychoanalysis, Sigmund Freud, Ego psychology, Nathaniel Hawthorne, The Scarlet Letter, Carl Jung


Despite recognizing that gender identity is a complex compromise formation, psychotherapists struggle to tolerate gender variance. We still tend to favor binary gender identities and clear developmental lines, rather than embracing a stance of subversive curiosity about the variability and fluidity of gender in our patients. When gender identity is fluid or ambiguous, countertransferential affective disturbances can arise that meld states of abjection and excitement, challenging theoretical constructs and threatening therapeutic neutrality. Case material from the treatment of a female-to-male trans person is presented from the perspective of the transference-countertransference matrix.

Concepts: Gender, Gender role, Gender identity, Transgender, Third gender, Homosexuality, Gender studies, Genderqueer


Three important areas of current inquiry concerning early trauma-the respective roles of reality and fantasy, age-related capacity for the symbolic representation of trauma, and attachment status-are approached through clinical case reports of three children seen initially at very early ages. The findings are relevant to the issue of whether preverbal infants can experience traumatic events that later are available to interpretation. The focus is for the most part on event traumas-single harrowing, life-threatening experiences-occurring at quite early ages. Three main points are emphasized. First, toddlers and infants (including neonates) can experience intense pain and show symptoms of traumatization. They are capable of experiencing an event as harrowing and life-threatening. Second, these events are capable of being memorialized or symbolically represented, that is, stored in memory in a way that can affect later behavior and learning. Third, how that traumatization resolves itself, or fails to, can be decisively affected by the functioning of the attachment system.

Concepts: Psychology, Infant, Psychological trauma, Pediatrics, Toddler


Over five years, from 1919 to 1924, Freud dealt with masochism in three texts written in close proximity: “A Child Is Being Beaten,” Beyond the Pleasure Principle, and “The Economic Problem of Masochism.” Initially Freud explains masochism as incestuous fixation on the father and regression to pregenital, sadistic ways of loving. Subsequently he considers it primarily as subservient to the death drive. This paper starts from an idea present in two of the three texts, but not developed by Freud, in which he refers to the role that the “qualitative” element of rhythm could play in the occurrence of pleasure in masochism. By means of this element traumatic aspects of the primary relationship with the object could be stored as fantasies in the body. In any staged masochistic fantasies of being beaten or in masochistic perversion, the pleasure of pain would lie in the attempt to “dream” the trauma not only in the imagination but also, “aesthetically,” in the body.

Concepts: Death, Psychological trauma, Psychoanalysis, Sigmund Freud, Torture, Hedonism, Sadomasochism, Sadism and masochism as medical terms


The intrapsychic mechanisms for the intergenerational transmission of suicide are not adequately theorized, though it is well known that a family history of suicide places survivors at increased risk for suicide. The suicide of a family member, particularly a parent, it is hypothesized, marks some survivors with a type of trauma associated with moral injury, which may produce an alteration in object relations with the emergence of what may be called a mysterious object. Under the press of these conditions, survivors may embark on what Apprey (2014) has termed an “urgent errand” in an effort to solve a problem in the anterior generation. Analysands with a history of familial suicide may bring symptoms of moral injury, a mysterious object relation, and a risk for suicide into the transference. The family history, life history, and literary work of the novelist Walker Percy, who had an extensive family history of suicide, provides evidence for the hypothesis linking moral injury, a mysterious object, and an urgent errand in such patients.

Concepts: Family, Fiction, Novel, Literature, Family therapy, Humanities, Psychoanalysis, Family history


자폐성 및 원시적 정신상태에 대한 경험은 강박성의 이해에 시사하는 바가 크다. 여기서 강박성은, 강렬한 감정 경험, 그리고 자신의 전능한 통제 밖에 존재하는 불가사의한 대상 (enigmatic object) 과의 분리사실을 당면할 때 기본적으로 수반되는 고통에 대처하기 위하여 경험을 대대적으로 단순화시키려는 시도라고 볼 수 있다. 더 나아가, 강박성 사고와 다변(verbosity)으로의 철퇴는 종종 생애 초기의 상실 경험과 분리성에 대한 때이른 자각과 연관이 있는데, 대상을 전적으로 통제하고 있다는 착각을 유지하기 위해 동원된다. 갈등상태인 욕망에 대한 해석이나, 마음의 억압되고 전치된 부분들 및 이들을 향한 방어를 언급하는 개입은, 이 환자군에서는 유의미한 치료적 변화를 가져오지 못한다. 나는 대안으로 이 환자들과는 원시적이고 비상징적인 (nonsymbolic) 정신기능 수준에서 작업을 할 것을 제안하는데, 이는 경험이 언어로 전달되고 역동적으로 해석되기 이전에 분석상황의 지금 여기에서 우선 겪어져야 한다는 의미이다. 나는 초기 상실의 경험을 감당하기 위해 자신의 감정을 죽이고 강박성으로 도피하는 한 환자의 분석사례를 통해 이러한 접근을 그려보고자 한다.


( 초록 ) 수많은 이론적-철학적 명제들이 Blatt의 광범위하고 탁월한 학문적 업적으로부터 나왔다. 그의 주요 연구 주제들은 (1) 인지, 특히 현실에 대한 마음의 지형도 혹은 표상; (2) 인본주의적인 요소들의 영향 (예컨데, 에이전시, 성장에 대한 열망, 게슈탈트, 균형 욕구 그리고 회복 탄력성); (3) 프로이트가 말한 역동적 무의식에 대한 끝없는 통찰, 이렇게 요약할 수 있을 것이다. 철학적 입장에서, Blatt은 ‘인지-인본주의적 정신역동'이라고 부를만한, 통합적 역량과 추종을 불허하는 업적들을 남겼다.


Experiences with autistic and primitive mental states have significant implications for our understanding of obsessionality. Consequently, obsessionality is seen as an attempt at a massive simplification of experience, in order to deal with the pain inherent in the encounter with intense emotional experience and with the separateness of an enigmatic object that eludes one’s omnipotent control. Moreover, early loss and a precocious awareness of separateness often play roles in the withdrawal to obsessional thinking and verbosity, and to an illusion of omnipotent control of the object. Interpretations focusing on conflicting desires, or linking repressed and displaced parts of the personality with the defenses against them, do not reach these patients in a way that facilitates psychic change. An alternative approach, it is suggested, is to work at primitive, nonsymbolic levels of mental functioning, where experience cannot be verbally communicated and dynamically interpreted, but must first be lived in the here and now of the analysis. This is illustrated through the analysis of a person trying to cope with the experience of early loss by deadening emotion and finding shelter in obsessionality.

Concepts: Psychology, Personality psychology, Concepts in metaphysics, Knowledge, Emotion, Art, Aesthetics, The Encounter


Given that surveys, as well as frequent observations by institute faculty, indicate that many candidates have difficulty finding control cases and maintaining immersion and that many graduate analysts face similar challenges, it would seem that psychoanalytic training does not prepare candidates adequately for finding patients and practicing analysis while in training and, for many, after they have graduated. Although external challenges are formidable, it is by identifying and making use of internal challenges to finding cases that candidates can develop an analytic mind: the identity, approach, and skills necessary not only to graduate but to have the choice to practice clinical psychoanalysis post-graduation. Some of the internal challenges and their manifestations in different phases of initiating analysis (referrals, initial consultation, recommendation) are discussed and two detailed examples are offered to illustrate the productive use of candidates' countertransferences in finding cases and maintaining immersion. Finally, recommendations for institutional solutions are provided.

Concepts: Scientific method, Psychology, Clinical psychology, Psychotherapy, Psychoanalysis, Sigmund Freud, Analytical psychology