To those for whom psychoanalysis is not a lived reality, psychoanalytic concepts can seem odd, abstract, alien, and out of reach. It is sometimes hard to believe they are, themselves, derived from actual human experience. (Location 149)
Freud regarded psychoanalysis as a form of treatment, but also as a new branch of science. (Location 156)
since 1939, there has been no Freud to adjudicate competing claims concerning the truly psychoanalytic. Consequently, psychoanalytic thought has been released to flow more naturally. Where there was one channel, now there are many. Where there was one tradition, now there are multiple schools, technical terminologies, and forms of clinical practice. Psychoanalysis is no longer the work of one individual. (Location 165)
many dismissive critics of psychoanalysis believe that knocking Freud, or taking easy shots at outdated features of his thought, is equivalent to demolishing psychoanalysis in its entirety. (Location 174)
Anyone who thinks that a familiarity with Freud’s work is equivalent to an understanding of psychoanalysis is out of touch; it is like believing that contemporary physics is contained in the work of Newton, or contemporary biology in Darwin’s opus. (Location 186)
Politics and economics have also played an important part in the inaccessibility of psychoanalytic ideas. Despite Freud’s own wishes, psychoanalysis, particularly in the United States, was thoroughly medicalized up until recently. The American medical establishment laid claim to psychoanalysis and ran it monopolistically. Thus the impression that psychoanalytic ideas were by their nature esoteric, highly technical, and accessible only to the officially initiated partially reflected the political elitism and financial interests of those who benefited from maintaining the impression that psychoanalysis was a highly technical medical specialty. (Location 262)
A restraint-of-trade lawsuit, successfully undertaken against the medically dominated American Psychoanalytic Association, has forced the opening of formally medical institutes to nonmedically trained professionals. All this has begun to effect a reversal of the traditional elitism and contrived obscurantism of psychoanalytic writing. Psychoanalysis is in the process of modernization; its ideas need to be made available to all who are interested. (Location 270)
INTRODUCTION TO THE 2016 EDITION
Psychoanalysis has of course continued to develop since the initial publication of this book, in part influenced by Stephen’s thinking and his generative and inspiring writing. He encouraged the development of a paradigm shift in psychoanalytic thinking, reflecting what he felt was already implicit but not directly formulated in the writing of most of the authors included in this book: humans are not best understood as isolated beings motivated by and struggling with the prefigured innate forces of sex and aggression; rather, human beings are fundamentally social, developing within, internalizing, and shaped by their relationships with important others in their lives. (Location 328)
This alternative vision is referred to as “relational psychoanalysis.” (Location 336)
Our inner experience, although still seen as holding troubling areas of psychic life, is now understood to function as the personally specific lens through which we construct our vision of external reality. (Location 370)
If a search for instinctual pleasure motivated human experience, how did we explain that children who live with an abusive parent cling to that parent despite the pain? To Fairbairn, there seemed to be no gratifying fantasy being played out. And even with a loving alternative available, exposure to the “reality” of their parent’s hurtful behavior did not change the child’s desire to stay. Fairbairn concluded that such a child’s perception itself was distorted not by conflicted internal drives but by the way they had come to “see” their abusive parent; it was as if they had come to recognize abuse and pain as love. He decided it was one’s lived experience growing up, not the expression of internally arising drives, that was shaping the lens through which we organize and understand our experience with others. Fundamentally people are searching for connection, not for drive satisfaction. (Location 376)
psicoanálisis freud fairbairn favorite pulsión
One who lives completely in “objective reality” has no subjective center, no sense of himself as a viable person. (Location 389)
Harry Stack Sullivan (chapter 3), interested in how childhood experience impacts one’s sense of self, offered an important early reformulation. Sullivan thought that what was out of our awareness was not formed by the super ego’s condemnation and rejection of internally arising impulses. Rather, we reject from our conscious minds what important others in our early life had found unacceptable and emotionally intolerable in us. The anxiety generated in the mother by these intolerable parts of the child becomes overwhelming and unbearable for him. A sense of self, Sullivan concluded, resulted from the consolidation of the remaining “acceptable” features, while the rejected aspects of self are held in a split off and unattended “not-me” area of mind. (Location 401)
Unlike Freud’s repressed unconscious wish, dissociated content carries no built-in energy pressing for expression. The experience that has been set aside from awareness holds ideas, memories, and perceptions that we prefer not to have and do not want to think about. Thus, their articulation requires the therapist to be more active, attending to what is avoided or lacking in the patient’s account rather than simply listening to the patient’s associations. (Location 421)
Although the analyst ultimately retains responsibility, we now consider analyst and patient as “co-creating” the analytic process, an area explored by Lew Aron, each necessarily bringing a personal subjectivity to the task. (Location 428)
The term intersubjectivity defines this newly conceptualized analytic process, underscoring the shift from a model of mind, which viewed human development as primarily an unfolding of predetermined internal potentials, to a two-person model, which holds social experience as the generative centerpiece. Contemporary analysts attempt, in different ways, to engage issues in their relationship with their patient, assuming that their way of being with the patient, not just their way of interpreting, is crucial to the patient’s growth. (Location 434)
Diferencia fundamental con psicoanálisis lacaniano, en donde el analista debe aspirar a ser una función que efectúa operaciones sobre el inconsciente del analizante, principalmente a través del efecto del lenguaje de sus intervenciones.
psicoanálisis cita relacional definición
some analysts look to their personal experience to help them better grasp what may be inaccessible for their patient, regarding their own fantasies or feelings as potentially registering some of the patient’s unspoken experience. (Location 454)
Within our contemporary vision of a psychoanalytic process, the roles of patient and analyst are no longer scripted but instead are creatively and uniquely formed within each analytic dyad. (Location 461)
As contemporary analysts, we have learned that a comfort with not knowing is often more conducive to a generative process than assuming authority and trumping the patient’s perspective with our own. (Location 463)
Soportar la incertidumbre genera un terreno fértil para el análisis.
incertidumbre psicoanálisis cita favorite
The analyst must think about how to help each specific patient, constantly considering what helps and what doesn’t help and trying to determine why this is the case. (Location 465)
Cómo se aborda la flexibilidad del método n los analistas lacanianos? Al menos en Lacan era súper creativo.
favorite psicoterapia técnica psicoanálisis cita flexibilidad
1 SIGMUND FREUD AND THE CLASSICAL PSYCHOANALYTIC TRADITION (Location 477)
FROM BRAIN TO MIND
Freud graduated from medical school at a time when the study of the physical structure of the brain was in its burgeoning infancy. The neuron, the individual nerve cell, had recently been isolated; techniques were being developed for tracing neural pathways; the enormous complexity of the brain was just beginning to be sensed. (Location 497)
The idea the patient has of his hand is central to the functional disability. It is not the nerves themselves that are damaged; something is disordered in the patient’s thoughts, thoughts about his hand. The (Location 505)
Freud, following Charcot, Bernheim, and other practitioners of medical hypnotism, demonstrated that hysterics suffered a disease not of brain but of mind. It was ideas, not nerves, that were the source of trouble. (Location 518)
Breuer, evincing the qualities that were to become crucial in a psychoanalyst—curiosity and a willingness to follow the patient’s lead—allowed her simply to talk. With some encouragement on his part, her associations would lead back to the point at which the symptom originally appeared, inevitably some disturbing, stressful event. Pappenheim and Breuer discovered that this talk and the emotional discharge produced when the memory of the original disturbing incident emerged had a curative effect. Through this process, which she called “chimney sweeping,” the symptoms disappeared (Location 526)
Hysteria was caused by trapped memories and the feelings associated with them, they argued. Those memories and feelings had never been lived through in an ordinary way; they had become split off from the rest of the mind, only to fester and rise to the surface in the form of disconcerting and seemingly inexplicable symptoms. If those symptoms were traced to their origins, their meanings would become apparent and the feelings would be discharged in a cathartic burst. Then the symptoms would disappear. (Location 539)
Freud introduced a very different hypothesis: The pathogenic memories and feelings were dissociated not because of a prior altered state of consciousness but because the actual content of those memories and feelings was disturbing, unacceptable and in conflict with the rest of the person’s ideas and feelings. (Location 552)
FROM HYPNOSIS TO PSYCHOANALYSIS
Freud began to find hypnosis less helpful in gaining access to pathogenic memories and feelings than he and Breuer had initially perceived it to be. As his clinical experience grew, Freud realized that what was most crucial to a permanent removal of symptoms was for the objectionable, unconscious material to become generally accessible to normal consciousness. (Location 564)
The hypnotic trance artificially circumvented the defense, gaining access for the analyst to the festering secrets. But the patient was the one who needed to know, and the patient could not know because the resistance to that particular memory (and similar associatively linked memories) was reinstated when the trance ended. Simply being informed of the secret by the analyst after the trance would give the patient only intellectual, not experiential, awareness of it. (Location 571)
The Topographic Model (Location 576)
The theoretical advances represented in the topographical model were accompanied by technical innovations. The clinical task shifted from the discovery of the hypnotized patient’s secrets by the analyst to the removal of the defenses against those secrets in the patient’s own mind. (Location 580)
Free Association
The patient says whatever comes into her mind, with no effort to screen or select thoughts, and is encouraged to become a passive observer of her own stream of consciousness: “Act as though … you were a traveler sitting next to the window of a railway carriage and describing to someone inside the carriage the changing views which you see outside” (Location 588)
As a strategic device, free association helps the analyst discern the patient’s secrets, the unconscious wishes, while the defenses remain active and can be addressed. (Location 591)
Transference and Resistance
Free association is impossible to do for very long, Freud discovered. The defenses block the emergence of thoughts too closely linked to the repressed secrets. (Location 595)
Furthermore, conflictual thoughts and feelings that constitute the center of the patient’s difficulties are soon transferred to the person of the analyst, who becomes an object of intense longing, love, and/or hate. (Location 596)
Transferencia como un tipo de resistencia.
The resistance to particular free associations is the very same force, Freud began to speculate, that drove the original memories out of consciousness in the first place. It is precisely this transference and this resistance that need to be exposed, identified, and dissolved. By analyzing the patient’s free associations and resistances to free associations, Freud believed, he could gain access to both sides of the pathogenic conflict: (1) the secret feelings and memories and (2) the defenses—the thoughts and feelings rejecting those secret feelings and memories. (Location 599)
Among Freud’s most important clinical observations was that the patient’s difficulties in the analytic situation (the resistance and transference) are not an obstacle to the treatment but the very heart of it. (Location 620)
favorite resistencia cita transferencia psicoanálisis
DREAMS
Dream interpretation reverses the process of dream formation, tracing the path from the disguised surface to the hidden secrets lying beneath. (Location 647)
The form that Freud delineated in his theory of dreams became the central structural pattern for his understanding of all important psychic phenomena. The structure of neurotic symptoms, slips of the tongue (Freudian slips), and motivated errors in general are all identical to the structure of the dream: a compromise is struck between an unacceptable thought or feeling and the defense against it. The forbidden material is allowed access into conscious experience only in disguised form. (Location 648)
censura defensa favorite síntoma sueño psicoanálisis cita
CHILDHOOD SEXUALITY
A final aspect of Freud’s early clinical discoveries was even more startling: If the memories of childhood sexuality were systematically peeled back to their troublesome core, they were invariably connected to an actual sexual encounter of one sort of another. These discoveries led Freud to the controversial theory of infantile seduction: The root cause of all neurosis is the premature introduction of sexuality into the experience of the child. (Location 688)
Freud arrived at the momentous conclusion, which he announced in a letter to Fliess in 1897, that many of the encounters probably had never taken place, that what he had taken for memories of events were memories of wishes and longings (Location 709)
The collapse of the theory of infantile seduction led in 1897 to the emergence of the theory of infantile sexuality. The impulses, fantasies, and conflicts that Freud uncovered beneath the neurotic symptoms of his patients derived not from external contamination, he now believed, but from the mind of the child itself. (Location 717)
psicoanálisis seducción cita sexualidad infancia neurosis etiología
But why is sexuality such a powerful motivator of difficulties in living? Freud’s clinical discoveries led him to rethink the nature of sexuality and its role in the mind in general. (Location 724)
The Theory of Instinctual Drive
Central among the internal stimuli are the sexual instincts. These appear as a broad array of tensions arising from different body parts, demanding activity to effect their discharge, Freud believed. Thus, for example, oral libido arises in the oral cavity (its source), creates a need for sucking activity (its aim), and becomes targeted toward and attached to something (generally external to the person) such as the breast (its object), which is required for satisfaction. The source and aim are inherent properties of the drive, Freud believed; the object is discovered through experience. Thus in feeding for purposes of self-preservation, the infant discovers that the breast is a source of libidinal pleasure; hence, through experience, the breast becomes the first libidinal object. (Location 732)
There was not a singular beginning of sexuality, in either a sudden awakening or a specific trauma (as the theory of infantile seduction had suggested). Sexuality has many, many tributaries (Freud called them “component instincts”). It does not begin as genitality, but in a diffuse sensuality, located in many different body parts, stimulated through the many different activities in the first years of life. (Location 747)
Polimorfismo sexual primaro qe lueg se organiza bajo la gnitalidad
desarrollo sexualidad libido freud
Many of the drive impulses are too objectionable to be allowed any gratification at all; elaborate defenses are built to keep them repressed or to divert them into harmless activities. Thus the river of adult experience is composed of the continuous flow from its infantile sources, now merged, disguised, blended together into what appears to be a transparent whole. (Location 754)
What happens to anal erotic impulses? Freud came to the conclusion that there is a continuous flow of anal as well as oral and phallic impulses into adult experience, and that a great deal of adult functioning is constructed either to provide disguised forms of gratification or effective defenses or, most often, complex combinations of gratification and defense. There are people, for example, who are expert at spreading disorder. They cannot tolerate tidiness, which they experience as repressive and suffocating. As guests, they always leave your house a good deal messier than when they arrived. (Location 761)
The Oedipus Complex
Psychic Conflict
The apparent transparency of mind is an illusion; the psyche and the personality are highly complex, intricately textured layers of instinctual impulses, transformations of those impulses, and defenses against those impulses. (Location 808)
THE AGGRESSIVE DRIVE
In 1920 Freud introduced what has come to be known as his dual-instinct theory, which granted aggression equal status with sexuality as a source of the basic instinctual energy that drives mental processes. (Location 849)
Freud thus moved from an early implicit political philosophy that was Rousseauian in tone to one more darkly Hobbesian. In his most widely read book on culture, Civilization and Its Discontents (1930), Freud painted a picture of man requiring culture for survival but, because of the instinctual renunciation it entailed, necessarily always being dissatisfied in some fundamental fashion. (Location 863)
FROM TOPOGRAPHY TO STRUCTURE
From his earliest differences with Breuer on the cause of repressed memories, Freud regarded conflict as the central clinical problem underlying all psychopathology. His favorite metaphors for the mind (and the analytic process) were military. (Location 869)
Growing clinical experience and conceptual sophistication led Freud to theorize that the unconscious wishes and impulses are in conflict with the defenses, not with the conscious and preconscious, and that the defenses cannot possibly really be conscious or accessible to consciousness. If I know I am keeping myself from knowing something, I must also know what it is that I am keeping myself from knowing. (Location 874)
When Freud began to perceive the basic conflictual seam in the psyche as not between conscious and unconscious but inside the unconscious itself, a new model, the structural model, became necessary to delineate the primary constituents of mind. (Location 884)
Consistent with Freud’s understanding of animal nature (drawn from the zoology and animal psychology of his day) was his view of people as “driven” to seek pleasure in a single-minded and rapacious fashion. In order to become acceptable, both to others and to oneself, one has to conceal from oneself these purely hedonic motives. The ego, with the aid of the internalized parental presences in the superego, represses and regulates bestial impulses in the id to maintain safety in a world of other people, Freud proposed. The result is a mind largely unknown to itself, filled with secrets and disavowed impulses, sexual and aggressive. It is the pressure of those impulses in the “return of the repressed” that creates the neurotic symptoms whose code Freud felt he had broken. (Location 893)
etiología neurosis freud psicoanálisis
FREUD’S LEGACY
2 EGO PSYCHOLOGY
The tradition known as ego psychology germinated in the 1930s in Vienna, was dispersed via the war into England, and eventually took firm root in America. (Location 940)
What distinguishes the ego psychology approach from other lines of thought is the careful preservation of Freud’s drive theory that underlies it. (Location 957)
ANNA FREUD: THE BUILDING BLOCKS OF DEFENSE THEORY
The structural model, introduced in 1923, depicted a more complex psyche containing a struggle among three internal agencies: ego, id, superego. According to this model, neurosis is the result of a compromise-formation worked out unconsciously among these fundamentally antagonistic parties: the id, pressing to gratify infantile wishes; the superego, striving to prevent this morally forbidden gratification; and the ego, mediating among the claims of the id, the superego, and the outside world. Displaying some sympathy for the id, the ego works out a strategy that allows a certain amount of instinctual gratification but channels this gratification through a complex system of clever defenses. The ego disguises the appearance of the id’s impulses, thereby both preventing social censure and keeping the impulses under careful regulation. For the neurotic person, these compromises between forbidden impulses and defenses result in complex, uncomfortable symptoms and a constriction of functioning (often involving sexual inhibitions or an inability to work and compete successfully). (Location 963)
Sigmund Freud had abandoned hypnotism because he had learned that it was not enough to lull the defenses into temporary inactivity; they needed to be directly, consciously engaged and interpreted. But Anna Freud’s exploration of the ego followed its defensive operations from specific, circumscribed, clearly discernible symptoms to its infusion into the entire character; aspects of one’s basic style of personality functioning could be rooted in defensive processes. If these unconscious defensive processes are not decisively brought out into the open, Anna Freud came to believe, the therapeutic impact of psychoanalysis was severely curtailed. Simply bringing id impulses into consciousness is like a Cold War rescue of a few East Berliners, which fails to address the continuing existence of the Wall and the remaining intricate security system. Freeing some has little impact on the fate of others approaching the same border; the guards themselves must be won over, the defensive machinery dismantled. (Location 994)
Anna Freud’s book The Ego and Mechanisms of Defense (1936) was a partial response to this problem. It became a psychoanalytic field marshal’s handbook, documenting and illustrating various unconscious defensive strategies of the ego, alerting the clinician to telltale signs of their operation in the patient’s psyche. Reorienting analysis from its concentration on tracking down id derivatives, Anna Freud defined the proper analytic attitude as “neutral,” an evenhanded oscillation in attention among all three parties in the neurotic construction, the id, the ego, and the superego. (Location 1022)
cita psicoanálisis psicología del yo
Depicting the pervasiveness of ego processes throughout all areas of personality functioning, Anna Freud established the ego itself as an object of psychoanalytic inquiry worthy of study in its own right. At the same time, she expanded the range of applications of psychoanalytic ideas from symptoms to character style and from psychopathology to varieties of normal personality functioning. (Location 1075)
An Assessment of Psychic Structure
Prior to the development of ego psychology, the clinical goal of psychoanalysis had been the release of trapped, unconscious energies. Freud had stressed a nondirective, nonsuggestive approach. Removing the debris clogging the stream was the task, not strengthening the channel through which it flowed. (Location 1161)
HEINZ HARTMANN: THE TURN TOWARD ADAPTATION
Sullivan and the interpersonalists (see chapter 3) stressed, like Hartmann, the shaping influence of the environment on personality, but Sullivan had abandoned Freud’s drive theory and thus his contributions were not considered psychoanalytic within the Freudian mainstream. Hartmann, on the other hand, carefully and ingeniously developed his innovations as extensions and elaborations of Freud’s basic vision. (Location 1178)
Hartmann put his emphasis on the notion that animals were designed, through the process of survival of the fittest, to be highly adapted to their surroundings, so that there would be a continual “reciprocal relationship between the organism and its environment” (Location 1208)
8 CONTROVERSIES IN THEORY
Psychoanalytic ideologies tend to inspire deep passions among their adherents that have sometimes impeded a constructive exchange of ideas. (Location 4822)
TRAUMA OR FANTASY: WHAT IS THE CAUSE OF PSYCHOPATHOLOGY?
If we had to select the controversy that has most divided psychoanalytic theorists and clinicians, the single issue that has given rise to the most impassioned, strident, and sharply contrasting beliefs, there is only one candidate, and there are no close seconds. That issue concerns the cause of psychological disorders: Is psychopathology the result of trauma, healthy development thrown off course by destructive events and actual experiences? Or is it the result of the misinterpretation of early experience due to the warping impact of early childhood fantasy? (Location 4834)
etiologia de la psicopatología
Freud’s exploration of infantile sexuality and the classical emphasis on the inevitable conflictual nature of instinctual drives eventually provoked a whole generation of relational theories that swung back to the other side of the dialectic, emphasizing experience once again. The key feature of this shift was the redefinition of “trauma” from a single, cataclysmic childhood event (like a sexual molestation) to parents’ chronic failure to meet the psychological needs of the developing child. The importance of this redefinition can be seen dramatically in Winnicott’s concept of impingement, and we will consider it as a prototype for a way of thinking that has characterized this entire generation of psychoanalytic theorizing. (Location 4859)
etiología de la psicopatología
psicopatología cita explicación historia psicoanálisis
impingement—the failure to protect the delicate state necessary for psychological growth and health. (Location 4871)
Impingement
Winnicott’s understanding of the way experience can become traumatizing is quite different from Freud’s. Trauma for Winnicott is not just the introduction of something dramatically negative, frightening, and noxious (e.g., precocious sexual stimulation); it is most fundamentally the failure to sustain something positive—the necessary conditions for healthy psychic development. Thus M. M. R. Khan (1963) termed Winnicott’s theory of the disturbing impact of a lack of good-enough mothering a theory of “cumulative trauma,” resonating with Freud’s earlier seduction hypothesis, but in a different fashion. (Location 4872)
teoría del traums acumulativo
In all these models, elements of Freud’s original pre-1897 seduction theory have been revived in a new and much more subtle and sophisticated form. The child is not traumatized by a sexual event, per se; the child is traumatized by parental character pathology. Because of the parents’ inability to provide what is necessary, because of the interfering impact of the parents’ own difficulties and anxieties, the child is distracted from the delicate project of becoming a person. Instead, attention becomes prematurely diverted to survival, to the parents’ needs, to self-distorting adaptation to the external world. (Location 4879)
etiologia de la psicopatología
psicopatología etiología desarrollo psicoanálisis cita
CONFLICT OR ARRESTED DEVELOPMENT: WHAT IMPEDES HEALING?
To see history as interpretive rather than simply uncovering does not detach it from reality; rather, it regards reality as knowable through different possible understandings that are partially constructed by the knower. (Location 5246)
psicoanálisis favorite hermenéutica historia
Thinking about psychoanalysis as a hermeneutic discipline is similar to thinking about history that way. What actually happened in a particular patient’s early life? What is actually happening now, both in the session with the analyst and in the patient’s life outside the sessions? The answers to these questions are infinite. The facts are infinite. What areas are most important to consider? Which among the innumerable bits of information are most relevant? In many respects the psychoanalyst is in a position analogous to that of the historian or the contemporary political analyst. She confronts an infinite array of possible data and seeks an understanding that, if it is to be helpful at all, must be highly selective and reductive. (Location 5248)
Psicoanálisis como práctica hermenéutica.
Spence argued that psychoanalysis deals more with “narrative truth” than with “historical truth.” The patient’s free associations do not simply contain expressions of underlying dynamics; the patient’s associations have to be constructed in some fashion. They are generally assembled, Spence demonstrated, according to the analyst’s preconceived theoretical commitments. (Location 5255)
sentido narrativa historia interpretación psicoanálisis creación
Schafer has applied hermeneutics in a very different way. In his view, all psychoanalytic understandings are necessarily reductive and operate along what he has termed “narrative storylines.” Each theory has its own preferred way of viewing reality, understanding life; each preselects its own villains, heroes, curative journeys. Psychoanalytic understanding, for Schafer, is fundamentally a narrative process, and unavoidably so. This does not make analytic interpretations random, relative, or fictional. As with good history, good psychoanalytic interpretations must also make sense, pull together as much of the known data as possible, provide a coherent and persuasive account, and also facilitate personal growth. Psychoanalytic narratives are developed in communities of clinicians and tested for their clinical utility over time. (Location 5260)
in a fundamental sense, contemporary psychoanalysis has been a method in search of a rationale. (Location 5273)