혁신라이프코칭연수원 ICC

http://club.koreadaily.com/icclifecoach
전체글보기 클럽방명록  공동체 영상 정보   ICC 안내자료   도시와 자연의 영상 
 
  클럽정보
운영자 simonshin
비공개 개설 2016.07.20
인기도 607836
회원 79명
공동체 영상 정보 (82)
ICC 안내자료 (97)
ICP 안내자료 (75)
도시와 자연의 영상 (90)
신현근 박사 영상 강의 
정신분석의핵심개념 (18)
애도와 상실 (10)
Karen Horney의 정신분석 (74)
대인관계 정신분석 2 (35)
자아심리학 2 (34)
고전적 정신분석 (Freud) (168)
병리적 자기애와 공격성 (Kernberg) (60)
자기 심리학 (Kohut) (81)
임상 기법과 임상감독 (12)
인간성장이론 (12)
전이와 저항 (60)
클라인(Klein) 학파의 대상관계 이론과 그 역사 (58)
정신분열증 (10)
상호주관적 관계적 정신분석 (38)
비온의 대상관계 이론 (22)
강의안과 발제문 
현대정신분석의핵심개념 (5)
라이프코치양성 (23)
진단과평가 (17)
현대갈등이론 (13)
전인격적라이프코칭 (8)
회원자료 (5)
무의식적환상 (22)
현대정신분석의개입기법 (35)
정서적의사소통 (15)
정신분석기법과정신적 갈등 (23)
정신분석적사례이해 (26)
방어기제 (24)
정신분석의역사 (47)
고전적 정신분석 기법 (19)
신경증이론 (23)
대상관계이론의역사 (14)
자아심리학 (23)
현대정신분석 이론 (25)
페어베언의 성격 이론 (24)
성년기 발달 이론 (13)
위니코트의 대상관계 이론 (19)
ICC의 목표
추천링크
ICC YouTube
ICC 웹사이트
ICP, Seoul Korea
ICC 대표 신현근 박사
ICC의 네이버 블로그
ICC의 Moment 블로그
혁신라이프코칭학회 ICS
ICC의 Facebook Page
ICS의 Facebook Page
HeyKorean ICC
한국일보 블로그
ICP YouTube
 
TODAY : 430명
TOTAL : 1106107명
현대정신분석 이론
작성자  simonshin 작성일  2018.04.11 16:29 조회수 663 추천 0
제목
 발제문 (박선자 연구원): 현대정신분석 (Modern Psychoanlysis)  
 

과목: 현대정신분석 이론

주제: 현대정신분석 (Modern Psychoanalysis)

교수: 신현근 박사                                      

내용: 발제문                                

발제자: 박선자 연구원

주교재:

Spotnitz, H. (2004). Modern psychoanalysis of schizophrenic patient: Theory of the technique (2004 2nd Ed.). New York: YBK Publishers.

하이만 스팟닛츠 지음. 이준호 옮김 (2006). 정신분열증 치료와 모던정신분석. 서울: 한국심리치료연구소.

부교재:

Snyder, J. (2015). Modern psychoanalysis. Modern Psychoanalysis, 40(2): 119-154.

 

Modern Psychoanalysis

  > 1.  A school of thought evolved from the application of traditional Freudian theory to analytic work with psychotic, borderline and other narcissistic disorders, borderline and other narcissistic   disorders, leading to new understandings of the analytic process and innovations in technique.

> 2. Modern analysts along with the Kleinians were the pioneers who recognized the critical importance of countertransference feelings as a window into the patient’s psychic world.

>  3. They have utilized traditional Freudian concepts such as his later dual theory and the need for drive fusion, the repetition compulsion, the role of unconscious conflict, and psychosexual stages,  in order to work effectively with narcissistic states.

> 4. Modern psychoanalysis emphasized the constructive use and management of aggression for healthy maturation.

> 5. They are theoretically similar to the Kleinian school , in that both theories highlight the role of  inborn aggression, and place an emphasis on preoedipal  phases of development and on the importance of unconscious fantasy in the construction of the object.

> 6. Other important concepts include a need for an early object-relational environment that provides opportunities for healthy tension discharge, and optional insulation from overstimulation, both from within the individual and from outside source.

> 7. They emphasize the danger posed by the lack of an insulation environment, potentially leading to the development of the “narcissistic defense”, conceptualized as a turning of aggression against the mind of self----- This is considered the dynamic root of psychosis-aggression is turned against the mind itself.

>  8. They expanded the concept of transference to include a concept of narcissistic or preoedipal transference, in which the analyst, or any emotionally important “other” (the “object” in psychoanalytic terms, is not distinguished from the self.

> 9. They have found that resolving the negative narcissistic transference is particularly important for progression to an object transference, in which the other is experienced as a separate individual.

> 10. At that point, traditional psychoanalysis  technique such as interpretation may be effectively utilized.

>  11.  Modern psychoanalysts conceptualize a sequence of  stages of resistance in the analytic process (treatment-destructive resistance, status-quo resistance, resistance to progress, resistance to cooperation, resistance to termination).

>  12. In common with contemporary intersubjective and relational schools of psychoanalysis, modern analysts use induced countertransference experiences to work emotionally in the  here-and-now of the transference.

> 13. Sometimes using emotional communications to address patient’s conflicts and increase acceptance of disavowed parts of the self in ways that don’t require patients to have a developed ability to reflect upon their experience.

> 14. A major contribution to the field by modern psychoanalysis: formulation and using techniques that are effective in providing an insulation environment for the Preoedipal patient and  fostering a narcissistic transference.

>  15. The emphasis is given to the understanding  the importance of enactment, as a mechanism  of communication and as basic to transference.

> 16. While the modern psychoanalytic focus on narcissistic  transference indicates a one-person intrapsychic perspective (the analyst is experienced as non-existent, or a part or twin image of the self).

>  17. The use of emotional induction and the induced countertransference in working  in the here-and-now of the transference is relational interaction that can be understood in a one-person or two-person frame depending on the object related versus narcissistic functioning of the patient at a particular point in treatment (Kirmass, 1998)

 

Basic theory: Preoedipal development, dual theory, and the narcissistic defense

1.1        The theory of mental development underpinning modern psychoanalysis is rooted in Freud’s later dual drive theory (Freud, 1920/1940),

1.2        Emphasizing the role of the aggressive as well as the libidinal of life drive and the importance of drive fusion.

1.3        Drive fusion is the power of the life drive to control and direct aggression for healthy development  and functioning in the world.

1.4  .1  The basic conflict between two drive --- the libidinal or life drive (also termed  ”eros”) vs  “thanatos” or death drive.

1.4.2   The evidence of death drive--- repetition compulsion, sadism, war

1.5.1   In this model of early psychic development, impulses for need satisfaction and motility arouses tension, which needs to be discharged.

1.5.2.  If needs are met in a “good enough” manner and the infant can experience satisfaction, tension is eased and managed and mental development proceeds with the development of pleasurably charged memory images, repetition of discharge patterns that bring relief, and the maintenance of optimal tension states to encourage perception, liking  of images, sensations, feeling states and action patterns, providing the basis for further mental development.

2.1.  In the narcissistic disorders, energy toward growth and development is tied up in managing inordinate destructive impulsivity ( inborn as temperament) or from early maturational failures which result in the development of the narcissistic defense, which is the direction of aggression toward one’s mind.

2.2.   These early failures include exchanges with a mothering figure (“object”) in which rage and early tension could not be discharged and relieved, leading to a buildup of excessive rage, tension, and destructive impulsivity, which was discharged against the early developing mind or ego.

2.3      Early exchanges with a mothering object could lead to an increase in tension due to overstimulation by the caretaker in the form of lack of attunement to needs or instrusiveness, or more overt forms of abuse or neglect ( Spotnitz  &  Meadow, 1995; Meadow  2003)

2.4   In these early states, self and object are not yet differentiated and direction of rage against the developing object impressions in the mind is a direction of rage against the developing mind itself, leading to fragmentation, continuing confusion of self and other as well as inner and outer reality, disturbed cognition and perception.

2.4.1  If repeated and severe, the result may be schizophrenia.

2.4.2  Other outcomes of narcissistic defense are psychosomatic disorder, depression and paranoia.

                                

Clinical examples: Narcissistic defense

A depressed patient repetitively described feeling hopeless, inadequate, and worthless  (the narcissistic defense).  At other times he was grandiose –others were despicable, beneath contempt, not worth association with.  He felt humiliated by the need for therapy, by his dependence on the analyst;  this filled him with rage, which led to great guilt and the desire to prostrate himself and be punished.   He vacillated between fantasies of sadistic torments to impose on the analyst and deep despondent and self attack.

 

Treatment process: Resolving blocks to maturation

1.      Modern psychoanalysis  works in a maturational frame- emotional difficulties are viewed as resulting from interferences or blocks to healthy maturation.  The analytic process therefore aims to resolve blocks to emotional maturation and healthy object relations.

2.      Spotnitz (2004)  describes the goal of analysis at a neurobiological level as one of “deactivating dysfunctional neuronal pathways and developing new neuronal pathways.” (essentially undoing or resolving the “block,”  the repetition compulsion).

3.      The analyst seeks to find the optional level of stimulation needed to each patient, mirroring the goals of early parenting, providing the optimal  amount and timing of verbal  “feeding” to facilitate the development of a transference,  an emotional relationship with the analyst that repeats important patterns in patient’s life.

4.      For narcissistic or regressed patients, the first transference will be a narcissistic transference.

 

Narcissistic transference

1.      The term narcissistic transference refers to the transfer of feelings and states experienced during the earliest period of development, before self and object were differentiated,  in other words when everything is experienced as part of the mind of the patient.

2.      It is a “re-experiencing of the ego in the process of formation. ( Spotnitz, 2004,P129)

3.      In the earliest phase of development, the other (in the treatment, the analyst) does not exist, later existing as part of the self, or as a twin image.

4.      The analyst does not question the perceptions of the patient but accepts them, becoming the repository for unwanted feeling and attributions, accepting all projection sand allowing herself to become the “object field.”

5.      In the negative narcissistic transference, the analyst becomes inadequate, hostile, unfeeling, stupid, exploitive, all of the   attributes the patient feels about himself.

 

Examples of negative narcissistic transference

1.      As he experienced the analyst’s acceptance of his sadistic urges, and also his ordinariness and inadequacy, he accepted her as more ordinary as well.

2.      He dealt with the loss of his sense of omnipotence with feelings of sadness and mourning and an acceptance of his own dependency feelings as he was moving into object transference.

3.      By helping the patient verbalize all negative feelings and accepting them the patient is enabled to “re-egotize” (take back into himself) formerly  unacceptable parts of himself.

4.      Critical  to the  analyst’s work is recognition and use of induced countertransference  feelings or what has been called “objective countertransference” ( Spotnitz & Meadow, 1995)

 

Induced  countertransference

1.               Recognizing the induced nature of feelings experienced when working with regressed patients may be difficult  - the analyst may find herself preoccupied with a somatic concern, or drifting into  a feeling-less, disconnected state, or suffering from intense feelings of inadequacy, feeling crazy or confused, experiencing sexual  feelings, or feeling irritable and anxious for the session to end.

2.               These feelings are usually experienced as subjective in the moment and require some self-analysis or consultation with a supervisor to recognize as an induction by the patient-mirroring the patient’s own preoccupations of emotional experience of lack of feeling.

3.               When with the narcissistic, preverbal patient, the feelings the analyst experiences during the session may be the primary means of communication (Meadow, 2003)

4.                Direct emotional contagion and induction from the patient prompt the analyst to experience certain feelings as well as the containment of expelled psychic contents from the patient.

5.               Meadow (1989) observes that the “resonance” experienced when the analyst allows himself to experience the patient’s earliest feeling states also generates feelings of  “connectedness” and “security”. 

6.               She notes (1989), “The meaning of the patient’s perceptions remains unclear during the preverbal period;  it is only our feelings which give us any clues.”  (P.152)

 

Case examples:  Countertransference induction 

1.               Yet I felt cut off, unmoved and became both self-attacking for my lack of affect and vaguely anxious that I was not doing a good job.

2.               Any occasional contacts I made in the form of questions or comments were rebuffed.  Over time, it became apparent that what I was experiencing was her constant state of mind- mild anxiety and a sense of inadequacy, a tendency to self attack, and a need to try to figure everything out rather than feel.     

 

Countertransference resistance

1.               The preoedipal patient will induce strong feelings, including feeling crazy, regeful, hateful, murderous, perversely sexual, out of control, or dead, to name a few ( Spotnitz,2004).

2.               Many analysts have noted the dangers of loss of ego boundaries as the analyst regresses with the more regressed patient, raising the possibility of acting on impulses or getting embroiled in “a chaotic fusion of patient and analyst.” ( Meadow, 1987, p244)

3.               The analyst defends against the anxiety of regression and loss of control with states of withdrawal, intellectualization, “excesses of self assurance based on primitive omnipotence ; abandonment of reality; submission to the patient; and repetitive excesses of self doubt, fear of exposure to one’s collegues and secrecy about how one works” (Meadow, 1987, p244)

4.               Resolution of the countertransference resistance is essential for progress in the treatment.

5.               A  common  countertransference  resistance is kindness  or being nice.

5.1           Meadow(1991)  notes that the analyst who is being kind is resisting regressing with the patient into early states, instead staying separate and benevolent.

5.2           The effect on the narcissistic patient is to feel worthless or the feel nothing, have no response.

5.3           Ogden(1992)  also warned the analyst against kindly and supportive comments to put the patient at ease.

5.4           He noted that the result  “put the patient into the analyst’s debt and puts pressure on him to return the ‘kindness’,  to help the analyst avoid feelings of discomfort”   (Ogdon,1992,p230)

 

Case examples:      Countertransference resistance

            As  analyst found herself defending herself when her enraged patient criticized her or accused her of not of not helping or being too emotionally uninvolved.  Instead of accepting the projections she asked a series of exploratory questions about why the patient felt that way.  The patient experienced these questions as distancing and became either angrier at the analyst or self attacking.  Eventually the analyst accepted her criticism against himself and she was relieved and began to express a fuller range of feelings toward the analyst.

 

Theory of technique

Modern psychoanalysts have developed techniques useful in facilitating the development of a narcissistic transparence and preparing the preoedipal or regressed patient for later stages of analysis.

 

Ego  Insulating  Techniques

            In working with  early narcissistic, the analyst operates to insulate the patient from overstimulation  by following the contact function, communicating in limited quantities, and avoiding contradicting the patient’s perceptions.  These techniques promote the development of the narcissistic transference.  Contacts from the patient,  usually questions or requests for information, are met with brief responses including reflections, joining statements, and brief exploratory or object oriented questions.

 

In the beginning: Contact function

            The modern analysts seeks to create an environment that is comfortable to the patient but also one in which early patterns of tension regulation can emerge, that is one  that is neither overestimating or overly gratifying, or overly depriving.  The analyst begins by responding to “contacts” from the patient.

            In the early sessions, the analyst assesses the optional level of stimulation for the patient by following the contact function, that is, responding only to direct requests from the patient for contact ( Meadow, 1990) and being guided by the nature of the contact in choosing the nature of the response.   The degree to which the patient makes and sustains contact with the analyst indicates the level of narcissism versus object-relatedness at which the patient is functioning  and , when observed over time, can provide a measure of analytic  progress.  (Margolis, 1983)

 

Object oriented questions

An object oriented question in “a question calculated to direct eh patients’ attention away from his own ego and toward objects or events external to himself.” ( Margolis.1983, p.187)                             The object oriented questions serves a number of functions :                                                   1). It models contact with another, thereby helping monologueing or silent patient to engage in a dialogue    2). It protects the patient who is over-disclosing or regressing or fragmenting   3). It leads to some reflection outside the self   4).  It enables and promotes the narcissistic transference  (Margolis, 1994a)

 

Joining techniques

Rather than challenging the patient’s perception or understanding of things, the analysts  echoing the patient, or affirming the patient’s  reception,  e.g. “seems that’s the case,” restating that the patient has been saying, “they are really taking advantage of you,” “life has been  one bad experience after another,” or asking exploratory questions to help the patient elaborate.  other  techniques include psychological reflection and mirroring.

Rreflection.   A question from the patient may be responded to with a question from the analyst, for example,  “How are you today?” met with “How are you today?” “Are you feeling tired?” “Are you?” The tone of reflecting comments is of critical importance.  When said with warmth and genuine interest,  they are usually effective.

 

Mirroring

Mirroring is a special type of reflection.  In mirroring, the analyst presents himself or herself as matching the patient in feelings, attitudes, effectiveness, etc. (Margolis, 1983)  These ego-insulating techniques are used to foster the narcissistic transference. 

Techniques resolving resistance to progressive communication include the joining techniques described, exploratory questioning and emotional communications.

 

 

 

Emotional communications

1.      Modern psychoanalysts use their repeated countertransference inductions to make  interventions in the here-and-now of the transference in a particular kind of intervention:  emotional communications.

2.      Emotional communications are direct emotional statements, questions or commands aimed to resolve a repetitive communication pattern and resistance to progressive communication.

 

Case example:

Emotional communication

1.      Emotional communications are offered in the here-and-now of the transference,  which explains their power. 

2.      The analyst is not offering  an interpretation but is living the countertransference-transference  here and now.

3.      It is not through enactment but through a feelingful communication  based on repeated experience with the patient,  in order to stimulate progressive communication of the patient’s fantasies and longings.

4.       The goal of emotional communication is to resolve the patient’s resistance to freely accessing and experiencing all feelings and saying everything.  Only action is discouraged. 

 

Resolving resistance

1.      The patient experiences difficulties in talking freely, remembering past experiences, fantasizing about possibilities, experiencing feelings, and even attending the sessions or arriving on time.  

a.       The analyst works toward helping the patient resolve this resistances to feeling,   thinking and saying everything.                                                                                                                              3.     Spotnitz defines resistance as “all the forces that prevent the patient from functioning with the analyst in an emotionally mature way” (Spotnitz, 2004, p.96).                                                                 

4.   Menninger defined the resistance as “the trend of forces within the patient which oppose the process of ameliorative change.  (Menninger, 1958, p.104).                                                                     

5.   Freud outlines five resistances that operate in an analysis: id (repetition compulsion or keeping things the same, unwillingness to give up freely expressing impulses), ego (repression of tension-arousing fantasies, memories leading to silence, superficial talk, jumps in topic) and super ego (guilt and need for self punishment  resulting in self attackand suffering )resistances.                                                                                                                                           6.   He also recognized secondary gain resistance  as well as transference resistance.                                                             7.   In addition to these resistances, modern psychoanalysts think about resistances occurring in stages in the treatment process. (Spotnitz, 2004)

8. These resistances include the treatment destructive resistance, status quo resistance, resistance to progress , resistance to cooperation, and resistance to termination.

 

Dreams

1.      Modern psychoanalysts work with dreams as part of the flow of association in the session, taking account of  what they are reported in relation to what other content, as well as the symbolic content.

2.      The manifest content of the dream is considered the route to the latent content, and a symbolic expression of not just repressed wishes but  “more primitive fantasies never articulated”(Spotnitz & Meadow, 1995).

3.       The patient may be asked what feeling was experienced in the dream or upon waking as a key to the affective meaning of the dream.

4.      Modern analysts are concerned with the affect expressed, experienced or defended against in the dream, as well as the symbolic content at the preoedipal as well as oedipal level.

5.      Dreams are the production of the unconscious in a regressed states, at one level every part of the dream is considered to be part of the dreamer.

 

Group Analysis

1.      Many modern analysts do group psychoanalysis finding that the possibility of multiple transferences in a group  holds the potential for aid to progress with a patient.

2.      Rosenthal(1994) states, “Groups activate, stimulate, and catalyze; they offer ongoing exposure to the emotional facts of life without the necessity for direct focus on egos and the invasive or toxic effects of such contact”(p160)

3.      Spotnitz found that many of the principles of individual psychoanalysis apply to group psychoanalysis---the analyst uses induces feelings, identifies resistances and works to resolve them.

4.      The emphasis is on the group resistance to cooperatively telling the emotionally significant story of their lives and helping the other members to do the same(Rosenthal, 2008).

5.      The therapist must “monitor the level of emotional stimulation in the group. The group setting has been likened to an emotional pressure cooker”(Rosenthal, 200%)

6.      The group analyst must monitor the tension levels manageable for the group, deal first with treatment destructive resistances and resistance to negative transference.

7.      The group analyst help the group to verbalize all feelings rather than engage in action.

8.      The group leader gives attention to the individual expressing the group resistance(e.g., the silent member, the jokester, the information seeker).

9.      The group will tend to avoid expressing negative feelings toward the analyst but may express them through behavior,  such as ignoring the analyst, indirectly giving a member the role of leader, forgetting to pay, coming late, engaging in small talk repetitively, allowing to a monopolizer to monopolize week after week.

 

Limitations of the modern psychoanalytic approach

1.      Modern psychoanalysis is much less developed as a theory  of technique with the post-oedipal, object–related patient, deferring to ”standard analytic technique” and deemphasizing work with more mature layers of the personality.

2.      Modern analysts have been criticized for over-emphasizing aggression and the aggression drive, and of neglecting libidinal forces including sexuality, love and longing, in the personality and in the transference.

3.      It would be beneficial to report more case studies of patient transitioning from narcissistic status to object relation in order to expand the knowledge base on how this is achieved.

4.      Expanding the theoretical repertoire is  case research and writing would be beneficial.

 

Summary and conclusion

1.      Modern psychoanalysis as a theory of technique has focused on understanding and treatment of preverbal conflicts.

2.      This is the arena of the narcissistic disorders---schizophrenia, major affective disorder, somatic disorders, paranoia, impulse disorders, and addictions--- destructive aggression is directed toward the self in the narcissistic defense.

3.      Techniques effective in working with these early states include (1). Maturational model of early development of mind, (2). Fostering narcissistic transference using ego-insulating techniques, (3). As the narcissistic transference is resolved, the patient begins to see the analyst as a separate person/object, (4). Throughout the analysis, the analyst relies on using induced countertransference states at times using emotional communication to resolve resistance to progressive communication, (5). Key to this process is the analyst’s resolution of her own countertransference resistance  to particular feeling states and experiences with the patient

4.      A sequence of resistances to analytic progress is resolved in the course of analysis, and the patient is helped to experience and express a full range of thoughts, fantasies, and feelings.

5.      The mature patient can then freely choose a course of action in all of life’s arenas of love, work and play.

  

 
 
 
 
이전글   다음글이 없습니다.
다음글   이전글이 없습니다.