Phyllis Tyson

Affects, agency, and self-regulation: complexity theory in the treatment of children with anxiety and disruptive behavior disorders

In an increasingly unsettled and violent world, with swelling numbers of children who are abused, abandoned, or neglected, emotionally if not physically, and an increasing population of aggressive preschool children with anxiety and disruptive behavior disorders who cannot be contained in ordinary settings, psychoanalysts can make a contribution. Early intervention is essential. In very early childhood, new procedural memories for interacting with others and for regulating affects can be formed more easily than they can ever be again. Intervention should aim toward helping the child develop a sense of agency, establish moral standards, assume self-responsibility, and attain the capacity for emotional regulation. The principles of complex dynamic systems can inform psychoanalytic treatment strategies, as demonstrated with five children whose cases are presented.

Infantile Sexuality, Gender Identity, and Obstacles to Oedipal Progression

Contrary to when it was first proposed, infantile sexuality nowadays is accepted as an important part of child development. However, Freuds views on masculine primacy and feminine inferiority are seen to be incomplete and inaccurate not only because they overemphasize sexuality and sexual anatomy, but also because they neglect aggression, object relations, ego and superego functioning, and the sense of self. Infantile sexuality is therefore reconsidered within the broader perspective of gender identity. Within this broader perspective, normal and aberrant sexual development is discussed, and new ideas are offered about familiar concepts such as castration anxiety and penis envy.

BEDROCK AND BEYOND: AN EXAMINATION OF THE CLINICAL UTILITY OF CONTEMPORARY THEORIES OF FEMALE PSYCHOLOGY

Libido theory and the idea of an innate matrix of bisexuality are an inadequate basis on which to understand female psychology. Rather, it is the mutual influence of sexuality, aggression, object relations, and a superego that inherits the object-related conflicts of early childhood, intertwined as these are with gender issues, that determine the way a woman experiences herself A woman can have a basically confident, narcissistically valued sense of femaleness and at the same time be troubled by intense feelings of inadequacy and deprivation. Instead of arbitrarily attributing these feelings to penis envy and a sense of castration, based on the idea of bisexuality as bedrock, this paper suggests that we consider primary femininity as bedrock, but that the superego, as heir to unresolved preoedipal and oedipal object-related conflicts, functions to maintain these painful emotions. Clinical material illustrates the utility of these ideas.

Narcissism and Superego Development

To elucidate the role of the superego in th maintenance of narcissistic equilibrium, we reviewed Freuds ideas about narcissism and the superego as well as the relevant theories of Kohut, Kernberg, and certain ego psychologists. These latter authors offer an alternative mode of understanding narcissism more consistent with Freuds structural theory, one in which signal affects and superego functioning play a central role in normal development and in the pathogenesis of narcissistic disturbances. Early steps in superego formation were then examined schematically to elucidate the interaction of environmental influences and emerging psychic structure. We suggested that the first step in a developmental line toward superego formation is based on the affective qualities experienced in the course of self-object differentiation. Subsequent steps examined were introject and ego-ideal formation; compliance with th object; compliance with the introject; identification with the introject and the ego ideal; and finally, with oedipal resolution, the integration of superego nuclei into a progressively structuralized autonomous superego system. This system achieves growing independence from the drives and from pressures from early introjects during the course of latency, and functions to maintain the demands of the conscience and the standards of the ego ideal; rewards or punishments result when these demands and standards are or are not met. The final stage briefly considered here was the revision, modification, and elaboration of moral codes and the ego ideal as part of the adolescent process. Narcissistic vulnerabilities at various stages were pointed out in an attempt to stress that a particular clinical picture in later phases of development or adulthood may derive from any of several development points of origin and from one or more etiological factors.

Neurosis in Childhood and in Psychoanalysis: A Developmental Reformulation

It is widely believed that the transference neurosis, understood as both a repetition of the infantile neurosis, and as an opportunity for new forms of object relations, is the hallmark of psychoanalysis. Because the concept has become caught up in such polemics over the years and has acquired such a variety of meanings, some call for its abandonment: some also call for abandoning the concept of the infantile neurosis. This paper argues that both these concepts refer to significant clinical phenomena and so rather than being abandoned, they should be clarified and redefined in the light of contemporary developmental theory.

A classic revisited : Loewald on the therapeutic action of psychoanalysis

Versions of the following papers were presented at the panel “Psychoanalytic Classics Revisited: Hans Loewalds ‘On the Therapeutic Action of Psychoanalysis’” (Gerald I. Fogel, chair) at the meetings of the American Psychoanalytic Association, December 1993. As a tribute to Loewalds lifetime of achievement, and in belated recognition of his preeminent position in the field of psychoanalysis, the exchange appears here almost in its entirety, rather than as a conventional panel report.

The Concept of Transference in Child Psychoanalysis

The authors suggest that transference evolution be distinguished from habitual modes of relating and from “real” aspects and other constituents of the patient-analyst relationship derived from the childs relatively immature but developing status. A categorization of transference is proposed as follows: transference of current relationships, of past experiences, and transference neurosis. While interpretations thus informed can be made more precise, they need to be formulated with constant awareness of the childs functional developmental level, as well as other aspects of psychoanalytic tact. Clinical examples illustrating the handling and interpretation of the various categories of transference are given.

Book Reviews: Psychoanalysis in a New Context.:

articulation of the core of psychoanalytically oriented psychothcrapy as one could wish. There is appropriate attention to latent and overt manifestations of transference and resistance. Well-chosen clinical examples illustrate his points. Although the manual is recommended both for the novice and for the experienced therapist, I consider this exposition most useful for the less expcrienced thempist. ‘There are dangers of rigidity and narrowness of focus. While Luborsky states tfiat he is not trying to present a “liow-to-do-it” manual, the manual does have a recipe quality. The therapist is to read and reread the manual as he conducts his psychotherapy and to do the same with the supervisor, going over the operational techniques point by point. T h e cxpericnced thcrapist may find the outline procedures too simplistic and that a single-minded pursuit of the CCRT does not do justice to the rich complexity and many phenomena attendant upon the interaction between patient and therapist. T h e hcavy emphasis on technique diminishes the contribution of the patient: the way in which tlie patient hears what the therapist says may be more imlwrtant thaii what the therapist says. The niodel advocated here may be more suitable with the less than the more severely ill patients, for wliorn great flcxibility, modifications, and parameters are often *required and where intense anxieties and primitive defense mechanisms cannot be understood in terms of the CCRT method. However, one could hardly expect that a manual of this kind could encompass a great range of strategies and maneuvers dictated by an extremely hetcrogenous patient population. Highly valuable as a training guide for students and teachers, this manual was written primarily for research purposes. It clearly presents what distinguishes psychoanalytic psychotherapy, and provides the tools accurately to assess tlie conduct and efficacy of therapy and to discern what elements, ranging from alliance to insight, make for good tlierapcutic progress and outcome. I t will be welcomed by practitioners and researchers alike.