From time to time, analytic therapists tend to re-examine their fundamental personal and theoretical perceptions, beliefs, and experiential knowledge of analytic processes. Currently, however, this mental action seems especially urgent amidst the massive volatile social, cultural, and political repercussions of the global COVID-19 pandemic. Our personal and public realities and our ways of living in them have dramatically changed—indefinitely. Moreover, some of the current challenges might change our lives beyond this global crisis and, therefore, analytic therapists need to revisit our conceptualization. To this end, this special issue of the American Journal of Psychoanalysis on current clinical issues in psychoanalysis offers new perspectives on human development, psychopathology, intrapsychic and intersubjective processes, and transference–countertransference relations. In this issue, various contemporary writers present their experiences, reflections, and theoretical suggestions regarding processes of change and personal growth within and outside the analytic process framework. While representing a diversity of analytic perspectives, the contributors to this issue are united in their dedication to introspective observation of their own and their patients’ moment-to-moment responses and communications in the analytic space; to learn and formulate something meaningful about human motivations, aspirations, ideals, and processes of change.
Kernberg (2021) addresses the future of psychoanalysis amidst the emergence of competing therapeutic approaches and the criticism raised against its effectiveness while ignoring its enormous scientific and cultural contributions to society. Kernberg believes that what weakens psychoanalysis is its lack of a clear and comprehensive definition as a school of thought and practice that requires specific competencies. He also sees as problematic psychoanalytic training organizations that are all too often authoritarian in their approaches, and a general professional conflict between viewing psychoanalysis as a scientific enterprise versus a humanistic one. Given the field's historical developments, Kernberg stresses the importance of re-conceptualizing and integrating analytic theoretical and technical principles and embedding them in the network of neighboring areas such as neurobiology, sociology, and organizational and historical studies. In addition, Kernberg suggests specific structural changes in psychoanalytic institutes, including the development of relevant research and ties with academia and the wider community. He also advocates greater receptivity to other disciplines, such as philosophy, art, and religion, and to the integration of humanistic, existential, and scientific aspects into the theory and practice of psychoanalysis.
Ahumada (2021) believes that Freud foretold the future development of psychopathology from the neurotic to the borderline and autistic phenomena by stating that the external world is what endangers people and gives them satisfaction. Ahumada offers a broad perspective on the evolution of humans as a special species that developed an inner world consisting of instinct, object, self, and special mind-body capacities of emotionality and sociability. A prominent factor in the evolution of the self is the mutual mother-child relationship that gives the child a sense of protection and facilitates the child’s self-reflectivity and self-recognition. Ahumada adds that traditional communities, including families characterized by mutuality and strong commitment, became dominated by contracts between people, which lack affectivity and reciprocity and invoke in people the delusion that they can create and recreate themselves and the world. Ahumada suggests that these recent cultural changes that intensified borderline disorder and autistic psychological conditions require amendment of the psychoanalytic process.
Civitarese (2021) describes Bion’s grid as a map of unconscious emotional attitudes of both patient and analyst, used primarily to construct their here and now, which can lead to either progression or regression. From this perspective, the individual analytic work is viewed as group work that concentrates on emotional transformations in the here and now of the analytic session. Furthermore, analytic materials are viewed as a dream text, capable of revealing the intersubjective reality and the analytic dyad’s emotional atmosphere. Civitarese’s examples deeply illustrate that the emerging analytic material is a dream shared by the patient and the analyst that expresses the emotional truth. He also illustrates how Bion’s theory might be linked with the theories of Klein and Winnicott to construct the multi-layered analytic reality.
Ferro (2021) examines the interrelationships between the concepts of play, negative capability, and other forms of negativity in the works of Bion, Winnicott, and Greene, which he describes as fundamental to contemporary psychoanalysis. Ferro explains that, in recent decades, analysts moved away from analyzing the analytic content and discovering the patients’ childhoods toward struggling to develop tools for narrating their experiences. He elaborates specifically on Bion’s concept of negative capability and describes it as the ability to tolerate enigma, mystery, the unknown, and uncertainty and as an indispensable medium for play. When holding a position of negative capability, therapists can play and engage in the mental activity of alphabetizing different forms of negativity weaved into our experience and thereby expand and enrich our minds.
Harris, et al. (2021) tell the stories of several analytic therapies, during the pandemic, with patients of different ages and life circumstances. The authors present transference–countertransference manifestations in these analytic environments and describe the patients’ and therapists’ struggles with their external and internal realities. Harris and her colleagues view both participants in the analytic space as experiencing après-coup phenomena that transform past dissociated experiences into traumatic experiences. The writers suggest that analytic processes cannot be understood without regarding the mental, cultural, and natural ecologies in which they occur.
Yerushalmi (2021) compares the listening of the supervisor to the supervisee’s narrative with the therapist’s process of listening to the patient’s associations. He suggests that focusing on the musical aspect of the supervisee’s narrative, such as intonations and rhythms, helps construct unsymbolized meanings and identify the patient’s voice concealed in the supervisee’s voice. Yerushalmi proposes the echo chamber metaphor to describe the supervisors’ implicit device of attending to the musical aspect of the therapeutic narrative in parallel to the metaphors of hovering attention and dreaming. The special characteristics of the echo chamber are used to explain its capacity to facilitate the discovery of hidden meanings and finding the uniqueness of each therapeutic narrative.
Despite the diversity of their vantage points, all the contributors highlight changes in how one views the process of clinical psychoanalysis. Kernberg suggests that it may be difficult to integrate insights from related areas of study and thought such as neurobiology, sociology, art, and philosophy into the understanding of internal changes. Ferro mentions the transformation in analytic thinking from reconstructing childhood experiences and deciphering analytic content to concentrating on the analytic dyad’s joint endeavor to create an analytic narrative. Civitarese points to the current emphasis in psychoanalysis on emotional transformations, rather than organizing patients’ past experiences in the here and now of the analytic process. Harris et al. highlight contemporary therapists’ need to include the patient’s and the therapist’s mental, social, and natural ecology contexts in their basic analytic consideration of clinical issues. Ahumada stresses the transition of the theoretical and clinical emphasis from the neurotic toward the borderline and autistic conditions. Yerushalmi reflects the change in analytic thinking by highlighting the search for meanings in the unsymbolized aspects of the discourse both in analysis and supervision.
The analytic process emerges from this collection of articles as a collaborative endeavor to create a change-promoting space in which both partners live through transforming experiences and discover new meanings of their own and their partners’ emotional responses. According to these theoretical contributions, the patient and the therapist can achieve these analytic goals if they develop the capacity to tolerate the unknown and the uncertain, become receptive to each other’s emotional states, and engage in a joint reflective process on their shared lived transference–countertransference experiences. This perspective appears to resonate with Ogden’s (2019) description of a recent shift in psychoanalysis from the epistemological perspective, characterized by the struggle to deepen the understanding of unconscious processes, toward the ontological perspective, characterized by the pursuit of experiencing aliveness and creativity within the analytic space.
One theorist who manifests this development in analytic thinking and practice and who represents this shift in psychoanalysis is Eigen (2012). He elaborates on the significance of the analytic dyad’s experiences of shared regressive states or “shared-madness” (p. 1457). Eigen, who draws on Winnicott, suggests that the most significant analytic experiences are the transient regressive states, shared by the two analytic partners, and the recovery from these states. These experiences are laden with reconstructions of traumatic and disintegrating past experiences characterized by loneliness, madness, and the sense of breakdown. Eigen explains that whereas using an object teaches us that the world can survive us, recovering from madness teaches us that we can survive ourselves. In the same vein, VanDerHeide (2012) suggests that, for patients, undergoing and surviving disintegrating experiences of anxiety and madness together with the therapist holds healing power. The healing element emanates from the fact that when patients believe that their experiences are distinctly irregular, they feel sequestered from the rest of the world, “different, relationally inadequate, misunderstood, socially ineffective, unacceptable, and misfit” (p. 383). Contrarily, when sharing such experiences with the therapists, the patients experience what Stolorow (2007) describes as self-validating “existential kinship-in-the-same darkness” (p. 50).